外伤性视交叉后段视路病变的临床分析

发布时间：2018-06-04 19:11

本文选题：视路 + 视交叉　；参考：《吉林大学》2011年硕士论文

【摘要】：目的: 外伤性视交叉后段视路病变在临床较为少见,常合并有颅底骨折或颅内出血,早期诊断比较困难,本文回顾性分析了解放军总医院近5年就诊的外伤性后视路病变患者的临床资料,分析其病因、临床表现、影像学特点及预后,做到早期诊断、早期治疗,对保护视功能具有重要意义。方法: 选择从2006年1月至2010年12月就诊于解放军总医院的颅脑外伤患者,共65人,对其相关因素进行分析,包括患者的一般情况(性别、年龄),受伤原因,损伤部位,视野改变类型,影像学表现及治疗预后。上述各种数据统计分析后得出外伤性后视路病变的好发年龄、性别,受伤主要原因,常见视野改变类型与影像学特点,用药后视野改善率与病程的相关性。结果: 1、外伤性后视路病变以31～40岁患者居多,占患病人数的46.2 %,其中,男性患者较多,43例,占患病人数的66.2 %,女性患者22例,占患病人数的33.8 %,男女患者性别构成比例为1.9:1。 2、视野缺损情况:非重叠性同向偏盲35例(53.8 %),重叠性同向偏盲21例(32.3 %),皮质盲8例(12.3 %),双眼同向偏盲性中心暗点1例(1.6 %)。65例病例中,14例(21.5 %)黄斑回避。 3、视野缺损与损伤部位的关系:视束损伤占5例(7.7 %),视野表现为非重叠性同向偏盲;外侧膝状体损伤未见;视放射损伤占11例(16.9 %),6例(9.2 %)表现为非重叠性同向偏盲,5例(7.7 %)为重叠性同向偏盲,其中3例(4.6 %)表现为黄斑回避;枕叶损伤占20例(30.8 %),4例(6.2 %)为非重叠性同向偏盲,9例(13.9 %)为重叠性同向偏盲,6例(9.2 %)为皮质盲,1例(1.5 %)为同向偏盲性中心暗点,其中8例(12.5%)表现为黄斑回避;多发损伤占29例(44.6 %),20例(30.8 %)为非重叠性同向偏盲,7例(10.8 %)为重叠性同向偏盲,2例(3.0%)为皮质盲,其中黄斑回避3例(4.6 %)。 4、用药后视野改善与病程的关系:65例患者根据病程时间长短分为4组,分别计算各组用药后视野改善的发生率。结果显示:第一组:病程时间≤1个月,用药后视野改善19例(29.2 %),未改善2例(3.1 %);第二组:病程时间1、≤3个月,用药后视野改善15例(23.1 %),未改善3例(4.6 %);第三组:病程时间3、≤6个月,用药后视野改善7例(10.8 %),未改善8例(12.3 %);第四组:病程时间6个月,用药后视野改善5例(7.7 %),未改善6例(9.2 %)。总计46例(70.8 %)视野改善,19例(29.2 %)视野未改善。第一组和第二组之间比较,差异无统计学意义(P 0.05),第二组和第三组之间比较,差异有统计学意义(χ2=3.438,P 0.05),第三组和第四组之间比较,差异无统计学意义(P 0.05)。病程3个月以内视野改善与大于3个月之间的比较,差异有统计学意义(χ2=10.787,P 0.05)。结论: 1大多数颅脑外伤导致的视交叉后段视路病变以31～40岁的年轻男性多见,诱因多见于车祸伤。 2外伤性视交叉后段视路病变较易导致患者视野的损害,患者可出现不同类型的视野改变,其中以非重叠性同向偏盲多见。 3早期给予营养神经、改善微循环的治疗,对于外伤性视交叉后段视路病变造成的视野缺损的恢复具有积极作用,并且3个月内给予相应药物治疗后视野改善可能性较大。
[Abstract]:Objective:
Traumatic posterior optic interasiasa optic lesion is rare in clinic. It is often complicated with skull base fracture or intracranial hemorrhage. Early diagnosis is difficult. In this paper, the clinical data of the patients with traumatic posterior optic pathway in the General Hospital of PLA in recent 5 years were analyzed retrospectively, and the etiology, clinical manifestation, imaging features and prognosis were analyzed, and early diagnosis was done. Early treatment is of great importance for the protection of visual function.
Method:
A total of 65 patients were selected from January 2006 to December 2010 at the General Hospital of PLA General Hospital. The related factors were analyzed, including the general situation (sex, age), the cause of injury, the site of injury, the type of visual field change, the imaging manifestation and the prognosis of treatment. The age, gender, main causes of injury, common visual field change type and imaging characteristics, and the correlation between visual field improvement rate and the course of disease were discussed.
Result:
1, the majority of the patients with traumatic posterior vision were 31~40 years old, accounting for 46.2% of the number of patients. Among them, there were more male patients, 43 cases, 66.2% of the number of patients, 22 cases of women, 33.8% of the number of patients, and the sex ratio of 1.9:1. for men and women was 1.9:1..
2, visual field defect: non overlapping homonymous blind 35 cases (53.8%), overlapping homonymous blindness in 21 (32.3%), cortical blindness (12.3%), 1 (1.6%).65 cases, and 14 cases (21.5%) macular avoidance in both binocular homonymous blind centers.
3, the relationship between visual field defect and injury site: 5 cases (7.7%) of optic tract injury, non overlapping Homo blindness, lateral geniculate injury, 11 cases (16.9%), 6 cases (9.2%) showing non overlapping Homo blindness, 5 (7.7%) overlapped homonymous blindness, 3 cases (4.6%) with macular avoidance; occipital lobe injury. In 20 cases (30.8%), 4 cases (6.2%) were non overlapping Homo blind, 9 (13.9%) were overlapping Homo blind, 6 cases (9.2%) were cortical blindness, 1 (1.5%) was Homo blind center, of which 8 cases (12.5%) showed macular avoidance; multiple injuries accounted for 29 cases (44.6%). Partial blindness, 2 cases (3%) were cortical blindness, including 3 macular withdrawal (4.6%).
4, the relationship between visual field improvement and course of disease after medication: 65 patients were divided into 4 groups according to the duration of the disease. The results showed that the first group: the course time was less than 1 months, the visual field was improved in 19 cases (29.2%) after medication, and 2 cases (3.1%) were not improved; the second group: the course time was 1, or less than 3 months, and the field of vision after medication was improved 1. In 5 cases (23.1%), 3 cases (4.6%) were not improved; the third group: the course time was 3, less than 6 months, the field of vision was improved in 7 cases (10.8%), and 8 cases (12.3%) was not improved.
There was no significant difference in the difference between the first and the second groups (P 0.05). The difference between the second groups and the third groups was statistically significant (x 2=3.438, P 0.05), and there was no significant difference between the third and fourth groups (P 0.05). The difference was statistically significant between the improvement of the visual field within 3 months of the disease and the comparison between the 3 months of the 3 months. X 2=10.787, P 0.05).
Conclusion:
1 most of the craniocerebral trauma caused by the posterior segment of optic chiasma is more common in young men aged 31~40 years.
2 the visual lesion of the posterior optic interasiasa is more likely to cause damage to the visual field of the patient, and the patients may have different types of visual field changes, in which the non overlapping Homo blindness is more common.
3 early nutrition nerve and improved microcirculation have a positive effect on the recovery of visual field defects caused by traumatic optic posterior optic interasiasa, and the possibility of improving the visual field after 3 months of treatment is more likely.
【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】：R779.1

【参考文献】