外伤性视神经病变临床诊治进展再探讨

发布时间：2018-06-26 17:50

本文选题：外伤性视神经病变 + 手术时机　；参考：《吉林大学》2010年硕士论文

【摘要】： 目的:探讨外伤性视神经损伤的损伤机制、诊治方式方法、手术时机、治疗原则及预后相关因素等,总结目前临床诊治进展,提高临床医师对此病的认识及诊治水平。方法:我们报道了6例病例,4男2女,年龄在19-36岁,均为车祸或高处坠落致伤,并出现不同程度的视力减退(或失明),视野缺失,额眶部皮肤创伤,出现典型的Gunn现象,不同程度的眼球运动障碍等。视神经管CT及三维重建提示不同部位的颜面部及视神经管壁骨折。均予以临床药物及手术治疗。总结诊治过程中的经验,并结合国内外文献,回顾性分析该病的损伤机制、治疗时机、预后情况等。结果:分别随访2-23个月,结果4例术前光感者视力均有不同程度的改善,2例术前失明患者无效。结论:1.药物辅以视神经管减压治疗,疗效较单纯药物治疗确切。对于伤后即出现失明患者,虽行减压及药物治疗,但预后不良。预后情况与损伤程度有关。 2.经颅视神经减压术视野开阔,不仅达到视神经的减压,同时也达到眼动脉减压。可一并处理颅内血肿及脑脊液鼻漏等。 3.因病例较少,在药物及手术治疗的对照研究、手术时机、各种手术方式对照等问题未能形成回归性分析,希望以后,能进行更大规模更深层次的探索。
[Abstract]:Objective: to investigate the mechanism of traumatic optic nerve injury, the methods of diagnosis and treatment, the opportunity of operation, the principle of treatment and the related factors of prognosis, and to summarize the progress of clinical diagnosis and treatment at present, and to improve the understanding and diagnosis of the disease by clinicians. Methods: we reported 6 cases with 4 males and 2 females aged between 19 and 36. All of them were injured by traffic accident or falling from a height, with varying degrees of vision loss (or blindness), lack of visual field, frontal and orbital skin trauma, and typical Gunn phenomenon. Different degrees of eye movement disorders and so on. Ct and three-dimensional reconstruction of optic canal indicated facial and optic canal fracture in different position. All patients were treated with clinical drugs and surgical treatment. This paper summarizes the experience of diagnosis and treatment, and analyzes retrospectively the injury mechanism, treatment opportunity and prognosis of the disease in combination with domestic and foreign literature. Results: after follow-up for 2 to 23 months, the visual acuity of 4 patients with preoperative light sensation was improved to some extent, and 2 cases of blindness before operation were ineffective. Conclusion 1. The effect of drug combined with decompression of optic canal is more effective than that of drug alone. Patients with blindness after injury were treated with decompression and medication, but the prognosis was poor. The prognosis was related to the degree of injury. 2. Transcranial optic nerve decompression not only achieved decompression of optic nerve, but also achieved decompression of ophthalmic artery. Intracerebral hematoma and cerebrospinal fluid rhinorrhea can be treated at the same time. Because of the small number of cases, the comparative study of drugs and surgical treatment, the timing of operation, and the control of various surgical methods can not form a regression analysis. It is hoped that in the future, more large-scale and deeper exploration can be carried out.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R774.1

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