影像导航下视神经减压术治疗外伤性视神经病

Traumatic optic neuropathy treated by imageguided optic decompression

摘要:

目的探讨影像导航下视神经减压术治疗外伤性视神经病（TON）的临床特点和预后影响因素。方法回顾性分析自2015年1月—2018年12月山西医科大学第二医院收治的20例TON患者的临床资料。通过单因素分析和非条件Logisitic回归分析评估不同因素对TON治疗效果的影响。结果术后随访3个月至1年，总有效率为60.0％（12/20），其中术前有光感及以上者有效率为100.0％（6/6），无光感者有效率为42.9％（6/14）。受伤1周内手术者，有效率75.0％（9/12）。术前CT显示视神经管骨折者，有效率为22.2％（2/9）。单因素与多因素结果均显示：术前视力、CT显示视神经管骨折是患者手术预后的影响因素。结论鼻内镜下视神经减压术是治疗TON的有效手段。术前有光感及以上是视力改善的保护性因素，术前CT显示视神经管骨折是视力无改善的危险性因素。对于伴有复杂颅面部外伤的患者，影像导航的应用可以达到精准定位，有效减压的目的，从而提高手术疗效，值得推广。

Abstract:

ObjectiveTo investigate the clinical characteristics and prognostic factors of traumatic optic neuropathy (TON) treated by imageguided optic decompression.MethodsThe clinical data of 20 patients with TON admitted to the Second Hospital of Shanxi Medical University from January 2015 to December 2018 were analyzed retrospectively.Univariate and nonconditional Logisitic regression analyses were used to evaluate the effects of different factors on TON treatment.ResultsPostoperative followup was conducted for 3 months to 1 years, and the total effective rate was 60.0% (12/20), among which the effective rate was 100.0% (6/6) for those with preoperative light perception, and 42.9% (6/14) for those without preoperative light perception.The effective rate was 75% (9/12) for who underwent surgery within 1 week of injury. Preoperative CT showed that the effective rate was 22.2% (2/9) in patients with optic canal fracture. Univariate and multivariate results were shown: preoperative visual acuity and CT showed optic canal fracture are the influencing factors of surgical prognosis of patients.ConclusionsNasal endoscopic optic nerve decompression is an effective method for treatment of traumatic visual mental derangement. Preoperative light perception and reserved visual acuity are protective factors for visual acuity improvement, while preoperative CT scan revealed a fracture of the optic canal is a risk factor.For patients with complex facial trauma, the application of image navigation can achieve the purpose of precise positioning and effective decompression. It is worthy of promotion for improve the surgical efficacy of the patients.