CAJ | 학술논문

目的探讨高压氧(hyperbaric oxygen,HBO)治疗对因外伤及手术受损的眶下神经功能恢复的疗效,并了解在HBO干预下这2种损伤后眶下神经功能恢复的预后差异.方法分析2008年3月以来在我院治疗的57例眶下神经损伤患者的临床恢复情况,其中38例因外伤冲击所致颧骨眶底骨折引起,18例行常规保守治疗(骨折对照组),20例在此基础上行HBO治疗(骨折HBO组)；另有19例因颧骨眶底骨折后手术复位引起眶下神经损伤,8例行常规保守治疗(骨折术对照组),11例在此基础上行HBO治疗(骨折术HBO组).治疗后1周以及1、3、6、12、24个月时复查,了解眶下神经功能恢复情况.以24个月的观察结果为基础判断眶下神经的恢复情况,再分别将2组的恢复状况做比较并行x2检验,以了解HBO对神经恢复的影响.另用x2检验比较2个HBO治疗组眶下神经恢复情况,以了解2种不同病因患者HBO治疗后的预后差异.结果骨折HBO组神经恢复的效果(好转率90.0％)明显优于骨折术对照组(好转率83.3％)(x2=20.8367,P＜0.05)；骨折术HBO组的神经恢复效果(好转率100.0％)也明显优于骨折术对照组(好转率87.5％),组间比较差异有统计学意义(x2=40.6526,P＜0.05)；使用HBO治疗的患者,手术组明显优于非手术组(x2=52.5148,P＜0.05).结论 HBO对外伤与手术损伤的眶下神经恢复有明显的效果,对手术后眶下神经损伤的患者效果更优.对治疗的时间、剂量及相关参数的选择尚待进一步探讨.
목적 탐토고압양(hyperbaric oxygen,HBO)치료대인외상급수술수손적광하신경공능회복적료효,병료해재HBO간예하저2충손상후광하신경공능회복적예후차이.방법 분석2008년3월이래재아원치료적57례광하신경손상환자적림상회복정황,기중38례인외상충격소치권골광저골절인기,18례행상규보수치료(골절대조조),20례재차기출상행HBO치료(골절HBO조)；령유19례인권골광저골절후수술복위인기광하신경손상,8례행상규보수치료(골절술대조조),11례재차기출상행HBO치료(골절술HBO조).치료후1주이급1、3、6、12、24개월시복사,료해광하신경공능회복정황.이24개월적관찰결과위기출판단광하신경적회복정황,재분별장2조적회복상황주비교병행x2검험,이료해HBO대신경회복적영향.령용x2검험비교2개HBO치료조광하신경회복정황,이료해2충불동병인환자HBO치료후적예후차이.결과 골절HBO조신경회복적효과(호전솔90.0％)명현우우골절술대조조(호전솔83.3％)(x2=20.8367,P＜0.05)；골절술HBO조적신경회복효과(호전솔100.0％)야명현우우골절술대조조(호전솔87.5％),조간비교차이유통계학의의(x2=40.6526,P＜0.05)；사용HBO치료적환자,수술조명현우우비수술조(x2=52.5148,P＜0.05).결론 HBO대외상여수술손상적광하신경회복유명현적효과,대수술후광하신경손상적환자효과경우.대치료적시간、제량급상관삼수적선택상대진일보탐토.
Objective To explore the therapeutic effect of HBO on infraorbital nerve injury induced by accidental impact or surgery,and also to study differences in the prognosis of neural functional recovery between these two lesions.Methods Recovery of 57 cases of infraorbital nerve injury treated in our hospital since March,2008,was analyzed.Of the 57 cases,38 (the traumatic injury group) had zygomatic orbital floor fractures due to traumatic injury,and 19 (the surgical reposition group) had infraorbital nerve numbness induced by surgical reposition following zygomatic orbital floor fractures.For the patients of the traumatic injury group,18 patients received conventional or conservative therapy,while another 20 patients were given HBO therapy in addition to conventional therapy.All the patients paid return visits,1 week,1 month,3 months,6 months,12 months and 24 months after treatment to find out recovery of infraorbital nerve function.Results of the 2-year examinations were used as reference data to judge if infraorbital nerve function was completely or partially recovered or failed to recover.Then,recovery of the patients in the 2 groups was compared and verified with chisquare tests,so as to know the clinical effects of HBO on the recovery of nerve function.In addition,chisquare test was used to compare the recovery of infraorbital nerve function in patients of the two HBO groups,and also to find out differences in the prognosis of the patients with different causes of disease,following HBO therapy.Results In patients with zygomatic orbital floor fracture induced by accidental impact,neural functional recovery of the HBO group was obviously superior (with an improvement rate of 90％) than that of the non-HBO group (with an improvement rate of 83.8％) (x2 =20.8367,P ＜ 0.05).In the patients that had infraorbital nerve numbness after surgical reposition,neural functional recovery of the HBO group was also obviously superior (with an improvement rate of 100％) than that of the non-HBO group (with an improvement rate of 87.5％) (x2 =40.6526,P ＜ 0.05).In the 2 groups of patients that all received HBO therapy,the prognosis of the patients that had infraorbital nerve numbness after surgical reposition was obviously superior than that of the accidental impact group (x2 =52.5148,P ＜ 0.05).Conclusions Research results indicated that HBO therapy could produce obvious effect on the recovery of infraorbital neural function damaged by trauma or surgical procedures,with the therapeutic effect on the cases induced by infraorbital neural damage after surgery being more superior.However,further research was required with respect to therapeutic time,dosage and selection of related parameters.