鼻内镜下视神经减压术对外伤性视神经病变疗效评价及预后因素分析

Effect and prognostic factors of endoscopic optic nerve decompression for traumatic optic neuropathy

摘要:

目的??探讨鼻内镜下视神经减压术对外伤性视神经病变（TON）的疗效及影响预后的因素。方法?回顾性分析2010年-2015年53例TON患者。按是否接受鼻内镜下视神经减压手术，将患者分为手术组及非手术组，应用χ2检验、成组t检验、多元线性回归分析统计学方法分析影响预后的可能因素。结果?在TON 53例（55眼）中，其中治疗前无光感31眼：手术治疗16眼，有效8眼，有效率50.0%（8/16）；保守治疗15眼，有效3眼，有效率20.0%（3/15）。治疗前有光感24眼：手术治疗14眼，有效11眼，有效率78.6%（11/14）；保守治疗10眼，有效3眼，有效率30.0%（3/10）。手术治疗30眼，无1例出现并发症，总有效率63.3%（19/30）。年龄、侧别、性别、治疗前有无光感、有无视神经管骨折及有无眶尖骨折与预后无相关性（P >0.05）；外伤到治疗时间是否超过3天及治疗方式与预后有明显相关性（P <0.05）。结论?鼻内镜下视神经减压术是TON的有效治疗方法。TON在3 d内进行治疗，有利于视力的恢复。

Abstract:

Objective?To study the curative effect and the prognostic factors of endoscopic traumatic optic neuropathy (TON).?Methods?The clinical data of 53 patients with TON from 2010 to 2015 years was retrospectively analyzed. Divided the patients into the surgery group and the non-surgery group, according to whether or not accept the treatment of endoscopic optic decompression. And evaluating the potential prognostic factors in chi-square test, group t-test and multiple regression analysis.?Results?In 53 patients (55 eyes ), 31 eyes have no visual acuity before treated: 8 eyes’ visual acuity was improved in 16 eyes (8/16) that accepted operation; 3 eyes’ visual acuity was improved in 15 eyes (3/15) that with non-operation; 24 eyes have visual acuity before treated: 11 eyes’ visual acuity was improved in 14 eyes (11/14) that accepted operation; 3 eyes’ visual acuity was improved in 10 eyes (3/10) that with non-operation; 19 eyes’ visual acuity was improved in 30 eyes (19/30) that accepted operation, the total effective rate was 63.3%, and there was no complications happened in the patients who accepted operation. The age, eye-side, sex, visual acuity, optic canal fracture , orbit fracture , all these factors have no correlation to the prognosis (P > 0.05), but the interval time between injury and operation (less than 3 days) and the way of the treatment are benefit to improve vision (P < 0.05).?Conclusions?The endoscopic optic decompression is an effective treatment in TON, and it’s better to improve vision in 3-day after TON.