CAJ | 학술논문

目的评价手术联合药物治疗外伤性视神经病(traumatic optic neuropathy,TON)的疗效,分析影响临床疗效的因素.方法对69例(70眼)确诊为TON并行鼻内镜下视神经管减压术联合药物治疗患者的临床资料作回顾分析.将入院时视力分为无光感、光感、眼前手动、眼前指数和能见标准视力表(0.02以上)5个级别,分别计为Ⅰ～Ⅴ级.入院视力Ⅰ级(无光感)者40眼,18眼因CT证实严重视神经管骨折,急诊行鼻内镜下视神经管减压术;22眼入院后先行糖皮质激素冲击治疗后再行手术治疗.入院视力I级以上者30眼,CT显示视神经管骨折的16眼行急诊手术;14眼行糖皮质激素冲击治疗3 d后行手术治疗.随访3～12个月,观察视力恢复情况.结果入院视力有光感者疗效显著优于入院视力无光感者(90.0%比27.5%),两组疗效相比差异有统计学意义(χ2=26.98,P<0.001).入院视力Ⅰ级患眼,糖皮质激素冲击治疗后视力提高者手术疗效(80.0%)优于无改变者(5.9%),两组疗效相比差异有统计学意义(χ2=12.09,P<0.001).结论对于无光感的患者,经药物冲击治疗后视力仍无改善者,手术疗效较差;治疗前视力是影响疗效的主要因素.影像学检查有无视神经管骨折,不应作为是否手术的决定因素.
목적 평개수술연합약물치료외상성시신경병(traumatic optic neuropathy,TON)적료효,분석영향림상료효적인소.방법 대69례(70안)학진위TON병행비내경하시신경관감압술연합약물치료환자적림상자료작회고분석.장입원시시력분위무광감、광감、안전수동、안전지수화능견표준시력표(0.02이상)5개급별,분별계위Ⅰ～Ⅴ급.입원시력Ⅰ급(무광감)자40안,18안인CT증실엄중시신경관골절,급진행비내경하시신경관감압술;22안입원후선행당피질격소충격치료후재행수술치료.입원시력I급이상자30안,CT현시시신경관골절적16안행급진수술;14안행당피질격소충격치료3 d후행수술치료.수방3～12개월,관찰시력회복정황.결과 입원시력유광감자료효현저우우입원시력무광감자(90.0%비27.5%),량조료효상비차이유통계학의의(χ2=26.98,P<0.001).입원시력Ⅰ급환안,당피질격소충격치료후시력제고자수술료효(80.0%)우우무개변자(5.9%),량조료효상비차이유통계학의의(χ2=12.09,P<0.001).결론 대우무광감적환자,경약물충격치료후시력잉무개선자,수술료효교차;치료전시력시영향료효적주요인소.영상학검사유무시신경관골절,불응작위시부수술적결정인소.
Objective To evaluate the therapeutic efficacy of combined treatment with surgical decompression and drug for traumatic optic neuropathy (TON) and analyze the influential factors. Methods A retrospective study on 69 patients (70 eyes) with TON treated with optic canal decompression through transnasal endoscopic approach and drug was conducted. The visualacuity was divided into 5 grades:no light perception (NLP), light perception (LP), hand move, count finger, >0.02, marked as Ⅰ-Ⅴ respectively. Of 40 eyes with grade Ⅰ, 18 eyes received emergency operation for severe optic canal fracture confirmed by CT;22 eyes received corticesteroid therapy firstly and then operation. Of 30 eyes above grade Ⅰ, 16 eyes with optic canal fracture confirmed by CT received emergency operation;14 eyes received corticosteroid therapy firstly and 3 days later received operation. Postoperative follow-up lasted 3-12 months to observe the recovery of visual acuity. Results The therapeutic efficacy of patients with the visual acuity of LP and above LP was better than that of NLP (90.0% to 27.5%), the difference had statistical significance (χ2=26.98,P<0.001). In operated group, the therapeutic efficacy in patients whose visual acuity was improved from NLP after glucocorticoid therapy (80.0%) was better than that of the patients with no improvement (5.9%), the difference had statistical significance (χ2=12.09,P<0.001). Conclusion The imaging findings of optic canal fracture can not be used as determinants for operation. The patients with NLP whose visual acuity had no improvement after corticosteroid therapy are poor candidates for surgical decompression. The visual acuity before treatment is the main factor affecting the therapeutic efficacy.