摘要
目的探讨视神经管减压术治疗创伤性视神经损伤(TON)的疗效,评估相关预后影响因素,并分析视神经管不同部位骨折手术策略选择。方法回顾性分析空军军医大学第二附属医院神经外科自2011年1月至2020年6月收治的58例TON后行视神经减压术患者的临床资料,采用单因素和多因素Logistic回归分析评价预后的潜在影响因素。根据视神经管骨折位置的不同,选择开颅视神经减压术和经鼻内镜减压术评估不同术式对不同骨折位置患者的术后视力改善情况的影响。结果58例TON患者均行视神经减压术,33例患者术后视力得到改善(改善组),其中9例行开颅视神经管减压术,24例行经鼻内镜减压术;25例患者术后视力未得到改善(未改善组),其中8例行开颅视神经管减压术,17例行经鼻内镜减压术。单因素和多因素Logistic回归分析确定术前视力及视神经管是否骨折是术后视力改善的独立影响因素,有光感者有效率明显高于无光感者,无视神经管骨折患者术后改善率明显高于有视神经管骨折患者。35例单发视神经管骨折患者中,视神经管内下壁骨折使用经鼻内镜视神经减压有更好的预后,开颅减压则对于外上壁骨折更有益。结论视神经管减压术治疗TON总体有较好的效果,尤其是对于术前尚存光感的患者。对于视神经管骨折患者应根据骨折位置选择合理的手术方式进行视神经减压。
Objective To investigate the efficacy of optic canal decompression in the treatment of traumatic optic nerve injury(TON),evaluate the related factors affecting the prognosis,and analyze the surgical strategy of different parts of optic canal fracture.Methods The clinical data of 58 patients who underwent optic nerve decompression after TON in the Neurosurgery Department of The Second Affiliated Hospital of Air Force Military Medical University from January 2011 to June 2020 were analyzed retrospectively.Univariate and multivariate Logistic regression analysis were used to evaluate the potential prognostic factors.According to the different positions of optic canal fractures,craniotomy optic nerve decompression and transnasal endoscopic decompression were selected to evaluate the effects of different surgical methods on the improvement of postoperative visual acuity in patients with different fracture positions.Results All 58 patients with TON underwent optic nerve decompression,and the postoperative visual acuity of 33 patients was improved(improvement group),including 9 cases of craniotomy optic nerve canal decompression and 24 cases of transnasal endoscopic decompression;The postoperative visual acuity of 25 patients was not improved(not improved group),including 8 cases of craniotomy optic canal decompression and 17 cases of transnasal endoscopic decompression.Univariate and multivariate Logistic regression analysis determined that preoperative visual acuity and optic canal fracture were independent influencing factors for postoperative visual acuity improvement.The effective rate of patients with light perception was significantly higher than that of patients without light perception,and the postoperative improvement rate of patients without optic canal fracture was significantly higher than that of patients with optic canal fracture.Among the 35 patients with single optic canal fracture,transnasal endoscopic optic nerve decompression had a better prognosis for the inner lower wall fracture of optic canal,and
作者
王航
蔡亚宁
衡立君
葛顺楠
屈延
Wang Hang;Cai Yaning;Heng Lijun;Ge Shunnan;Qu Yan(Department of Neurosurgery,The Second Affiliated Hospital of PLA Air Force Military Medical University,Xi’an 710038,China)
出处
《中华神经创伤外科电子杂志》
2022年第1期23-27,共5页
Chinese Journal Of Neurotraumatic Surgery：Electronic Edition
基金
国家自然科学基金(82130038)。
关键词
创伤
视神经管骨折
视神经损伤
开颅
内镜
Traumatic
Optic canal fracture
Optic nerve Injury
Craniotomy
Endoscopic
