影响外伤性视神经病变患者视力预后的主要因素分析

发布时间：2018-06-04 07:44

本文选题：外伤性视神经病变 + 眶壁骨折　；参考：《吉林大学》2011年硕士论文

【摘要】：由于生活方式的改变和CT等各类检查手段的不断进步,越来越多的眼科医生能够准确的认识并发现外伤性视神经病变(Traumatic Optic Neuropathy, TON)的患者。在各类国内外文献中,外伤性视神经病变患者的受伤途径、致盲原因以及视力损伤程度、外伤到治疗前时间、治疗方法等影响因素方面的研究结论虽然有些共同认识,但是分歧较大。在对这类病人的研究中,其致盲原因以及视力损伤程度与可能伴发的不同类型的眶壁骨折的关系研究结果甚少,针对TON患者的相关治疗手段以及治疗的结果也同样众说纷纭。所以,在眼外伤病人较多、规模较大、能够满足术后随访要求的的眼科中心进行一个以眼科医生为主体的系统性临床研究是非常有价值的。以眼科医生为主体,以中国东北地区中心城市长春的一个眼科中心(吉林大学第二医院眼科医院)收治的外伤性视神经病变的病人为研究对象,研究分析其基本临床流行病学特征、视神经管及眶壁骨折的CT影像学特点、合并眶壁骨折的TON临床特征以及相关诊断及治疗原则,归纳和总结分析TON患者是否合并眶壁骨折及骨折类型、受伤后视力、受伤到治疗的时间、不同治疗手段等影响外伤性视神经病变患者视力预后的主要因素。本研究为回顾性研究。纳入研究范围病例包括伴有或不伴有眶壁骨折的外伤性视神经病变患者以及同期入院治疗的眶壁骨折患者。对于外伤性视神经病变患者,治疗方法包括激素冲击疗法、视神经管鼻内窥镜手术减压法以及本课题组前期工作中的翼点入路视神经管手术减压法。 64例66眼外伤性视神经病变患者中,27眼不伴发眶壁骨折,39眼伴发眶壁骨折。既同期眶壁骨折患者(579眼)中,6.7%伴发外伤性视神经病变(39眼)。 ①TON是否伴发眶壁骨折对伤后视力及预后视力影响的研究结果：伴发眶壁骨折的TON患者39眼,20眼伤后无光感,17眼光感/手动/指数,2眼视力0.05以上,其中8眼治疗后视力有提高；无伴发眶壁骨折的TON患者27眼,10眼伤后无光感,11眼光感/手动/指数,6眼视力0.05以上,其中10眼治疗后视力有提高。应用列联表卡方检验对伤后视力相关数据进行分析可得,|Z|=2.73,在拒绝域内,故伴发眶壁骨折患者伤后视力与不伴发眶壁骨折患者伤后视力差异有统计学意义。应用列联表卡方检验对预后视力相关数据进行分析可得,|Z|=3.00,在拒绝域内,故伴发眶壁骨折患者预后视力与不伴发眶壁骨折患者预后视力差异有统计学意义。 ②伴发眶壁骨折类型对TON患者视力及预后视力影响的研究结果：对TON伴发外壁相关骨折21眼,治疗后2眼视力有提高；TON伴发内壁相关骨折19眼,治疗后5眼视力有提高。上述病例中,内壁骨折与外壁骨折皆有临床意义的患者在两组中重复计数。应用列联表卡方检验对数据进行分析可得,|Z|=1.97,在拒绝域内,故外壁相关骨折患者预后视力与内壁相关骨折患者预后视力差异有统计学意义。 ③受伤后到治疗前时间的间隔对TON患者视力及预后视力影响的研究结果：TON患者伤后3天内接受治疗30眼,治疗后13眼视力有提高；TON患者伤后3天后接受治疗36眼,治疗后6眼视力有提高。应用列联表卡方检验对数据进行分析可得,|Z|=4.12,在拒绝域内,故伤后3天内接受治疗预后视力与伤后3天后接受治疗预后视力差异有统计学意义。 ④受伤后残存视力对TON患者视力预后影响的研究结果：伤后无光感30眼,治疗后2眼视力有提高；伤后视力光感/手动/指数者27眼,治疗后14眼视力有提高；伤后视力0.05及以上者9眼,治疗后3眼视力有提高。应用列联表卡方检验对数据进行分析可得,R=5.13,否定H0,故p1=p2=p3不成立,故伤后视力不同对患者预后视力差异有统计学意义。 ⑤治疗方法的选择对TON患者视力预后影响的研究结果：全身接受激素治疗38眼,13眼视力有提高；经鼻内镜行视神经管减压术13眼,3眼视力有提高；(前期工作)开颅视神经管减压术30眼,10眼视力有提高。应用列联表卡方检验对数据进行分析可得,R=1.22,不否定H0,故p1=p2=p3成立,故三种治疗手段对患者预后视力造成的差异无统计学意义。我国东北地区外伤性视神经病变患者中伴发眶壁骨折占同期眶壁骨折患者(579眼)的6.7%。外伤性视神经病变患者伴发的眶壁骨折情况(是否伴发骨折以及骨折类型)是影响患者伤后视力和预后视力的重要因素。伴发眶壁骨折患者伤后视力差于不伴发眶壁骨折患者；伴发眶壁骨折患者视力预后差于不伴发眶壁骨折患者；伴发外壁相关骨折患者视力预后差于伴发内壁相关骨折患者；而本组中59%TON患者伴发眶壁骨折,也不失为TON患者普遍预后视力较差的原因之一受伤到治疗的时间长短明显影响外伤性视神经病变患者视力预后。伤后3天内接受治疗效果优于伤后3天后接受治疗患者；伤后残存视力是影响外伤性视神经病变预后视力的又一重要因素。伤后无光感患者,无论采取何种治疗手段,视力基本无提高可能,预后视力极差；伤后视力光感/手动/指数患者,视力提高人数比例较高；伤后视力0.05及以上者,视力提高人数比例高于无光感患者,低于光感/手动/指数患者；对治疗方法的评价表明,不同的治疗手段对外伤性视神经病变患者视力预后的影响不大。
[Abstract]:More and more ophthalmologists have been able to accurately recognize and discover patients with traumatic optic neuropathy (Traumatic Optic Neuropathy, TON) due to the change of lifestyle and the continuous progress of various methods such as CT. In all kinds of domestic and foreign literature, the way of traumatic optic neuropathy, the cause of blindness and the damage of visual acuity In the study of this type of patients, the cause of blindness and the degree of visual impairment with the different types of fracture of the orbital wall and the related treatment for TON patients are very small. The results of the means and treatment are also different. Therefore, it is of great value to carry out a systematic clinical study based on the ophthalmologist in the ophthalmology center with more ocular trauma patients and larger scale, which can meet the follow-up requirements after the operation.
Taking the ophthalmologist as the main body and taking the patients with traumatic optic neuropathy treated in one eye center (Second Hospital of Jilin University) in the central city of Northeast China (Jilin University second hospital), the basic clinical epidemiological characteristics, CT imaging features of optic canal and orbital wall fracture, and TON of orbital wall fracture were combined. The clinical features and the principles of related diagnosis and treatment are summarized and summarized to analyze whether TON patients merge with orbital wall fracture and fracture type, visual acuity after injury, time of injury to treatment, and the main factors that affect visual prognosis of patients with traumatic optic neuropathy.
This study included a retrospective study. The included cases included patients with traumatic optic neuropathy accompanied by or without orbital fracture and orbital wall fractures in the same period. For patients with traumatic optic neuropathy, the treatment methods included hormone shock therapy, optic canal nasal endoscopic decompression, and the subject group. Pterional approach for decompression and decompression of optic canal in previous work.
Of 64 cases of 66 eyes with traumatic optic neuropathy, 27 eyes did not have orbital wall fracture and 39 eyes were associated with orbital wall fracture. In the same period, 6.7% of the orbital wall fractures (579 eyes) were accompanied by traumatic optic neuropathy (39 eyes).
(1) the effect of TON with orbital wall fracture on visual acuity and visual acuity after injury: 39 eyes of TON patients with orbital wall fracture, 20 eyes without light sensation, 17 eye sense / manual / index, 2 eyesight more than 0.05, of which 8 eyes were improved after treatment; 27 eyes of TON patients without orbital wall fracture, 10 eyes without light sensation, 11 eye sense / The visual acuity of 6 eyes was above 0.05, and the visual acuity after 10 eyes was improved. The vision related data of the post injury was analyzed by using the combined table chi square test. |Z|=2.73, in the rejection domain, the visual acuity difference between the patients with orbital wall fracture and without orbital wall fracture was statistically significant. The prognosis of visual acuity related data can be analyzed. |Z|=3.00, in the rejection domain, the visual acuity of the patients with orbital wall fracture and the prognosis of the patients without orbital wall fracture is statistically significant.
(2) the results of the effect of the type of orbital wall fracture on visual acuity and prognosis of TON patients: 21 eyes with TON associated with external wall fracture and improved visual acuity in 2 eyes after treatment; 19 eyes with TON associated internal wall fracture and 5 eyes improved after treatment. In the above cases, the patients with internal and external wall fractures were clinically significant in the two group. The analysis of the data was obtained by using the square table card square test. |Z|=1.97, in the rejection domain, the prognosis of the prognosis of the patients with the external wall related fracture was statistically significant with the prognosis of the patients with the internal wall related fracture.
(3) the results of the effect of the interval between the injured and the pre treatment time on the visual acuity and the visual acuity of TON patients: 30 eyes were treated within 3 days after 3 days after injury and 13 eyes were improved after treatment. 36 eyes were treated in 36 eyes 3 days after injury and 6 eyes were improved after treatment. The data were analyzed by using the contingency table test, |Z|=4.1 2, in the rejection area, 3 days after injury, the prognosis of visual acuity was significantly different from that of 3 days after injury.
(4) the effect of visual acuity after injury on the visual prognosis of TON patients: no light sensation after injury in 30 eyes, 2 eyes improved after treatment, 27 eyes of visual acuity / manual / index after injury, 14 eyes improved after treatment, 9 eyes of 0.05 and more eyes after injury, and 3 eyes improved after treatment. Row analysis can be obtained, R=5.13, negate H0, so p1=p2=p3 is not established, so different visual acuity after injury has a statistically significant difference in the prognosis of patients.
The effect of the choice of treatment on the visual prognosis of TON patients: total body receiving hormone therapy in 38 eyes, 13 eyes improved visual acuity, 13 eyes of optic canal decompression through nasal endoscopy, 3 eyes improved visual acuity, 30 eyes of craniotomy optic canal decompression and improvement in 10 eyes. Analysis can be obtained, R=1.22, does not negate H0, so p1=p2=p3 was established, so the three treatment methods on the prognosis of patients with visual acuity difference is not statistically significant.
The orbital wall fractures in patients with traumatic optic neuropathy in Northeast China accounted for 6.7%. of the orbital wall fracture patients (579 eyes).
The cases of orbital wall fracture associated with traumatic optic neuropathy (or not with fracture and fracture type) are important factors affecting the visual acuity and prognosis of the patients after injury. The visual acuity of the patients with orbital wall fracture is worse than that of the orbital wall fracture, and the prognosis of the patients with orbital wall fracture is worse than that of the patients without orbital wall fracture. The visual prognosis of the patients with associated external wall fracture is less than that of the patients with internal wall related fractures, but in this group 59%TON patients with orbital wall fracture are also one of the causes of poor prognosis in the patients with TON.
The duration of the injury to the treatment was significantly affected by the visual prognosis of the patients with traumatic optic neuropathy. The treatment effect within 3 days after injury was better than that of the patients after the injury 3 days after the injury.
Visual acuity after injury is another important factor affecting the visual acuity of traumatic optic neuropathy. No light sensation after injury, no matter what treatment, visual acuity is not improved and the prognosis is very poor; the visual acuity / manual / index patient after injury is higher than that of the case; the visual acuity is 0.05 or more after injury. The proportion of high person was higher than that of non photoreceptor patients, lower than light perception / manual / index patients.
Evaluation of treatment methods showed that different treatments had little effect on visual prognosis of patients with traumatic optic neuropathy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R774

【相似文献】