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中华眼科医学杂志(电子版) ›› 2017, Vol. 07 ›› Issue (06) : 263 -268. doi: 10.3877/cma.j.issn.2095-2007.2017.06.005

所属专题： 文献；

论著

视神经管减压术与激素冲击疗法治疗视神经损伤的疗效比较
秦虎1, 汪永新1, 李亚宾1, 刘冬1, 朱晓锋1, 徐丹书1, 王增亮1,†()   
  1. 1. 830054　乌鲁木齐，新疆医科大学第一附属医院神经外科
  • 收稿日期:2017-08-25 出版日期:2017-12-28
  • 通信作者: 王增亮
  • 基金资助:
    新疆医科大学科研创新基金(XYDCX2015120)

Comparison of optic canal decompression and hormone shock therapy in the treatment of optic nerve injury

Hu Qin1, Yongxin Wang1, Yabin Li1, Dong Liu1, Xiaofeng Zhu1, Danshu Xu1, Zengliang Wang1,†()   

  1. 1. Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
  • Received:2017-08-25 Published:2017-12-28
  • Corresponding author: Zengliang Wang
  • About author:
    Corresponding author: Wang Zengliang, Email:
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引用本文：

秦虎, 汪永新, 李亚宾, 刘冬, 朱晓锋, 徐丹书, 王增亮. 视神经管减压术与激素冲击疗法治疗视神经损伤的疗效比较[J]. 中华眼科医学杂志(电子版), 2017, 07(06): 263-268.

Hu Qin, Yongxin Wang, Yabin Li, Dong Liu, Xiaofeng Zhu, Danshu Xu, Zengliang Wang. Comparison of optic canal decompression and hormone shock therapy in the treatment of optic nerve injury[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2017, 07(06): 263-268.

目的

比较视神经管减压术与激素冲击疗法治疗视神经损伤的效果。

方法

纳入2010年12月至2017年5月于新疆医科大学第一附属医院神经外科接受治疗的68例(68只眼)视神经损伤患者的临床资料，全部患者均为单眼受损。其中，男性49例，女性19例；左眼患病者38例，右眼患病者30例；交通伤患者31例，高处坠落伤患者22例，摔倒损伤患者15例。患者年龄为21～58岁，患者平均年龄为(35.6±3.4)岁。于伤后12 h内就诊者22例，12～24 h就诊者8例，1 d～3 d就诊者15例，4 d～7 d就诊者15例，7 d～30 d就诊者8例。按照不同的临床治疗方法，将患者分为手术治疗组与激素冲击治疗组。其中，手术治疗组41例，男性28例，女性13例，平均年龄(36.1±3.8)岁，平均病程(6.2±2.8)d，均行视神经管减压术治疗；激素冲击治疗组27例，男性6例，女性21例，平均年龄(34.5±3.1)岁，平均病程(6.7±3.1)d，均给予单纯激素冲击疗法治疗。均于术后或开始治疗后3 d、7 d及30 d时观察两组患者的视力及眼底情况。手术后或治疗后视力好转者判为有效，手术后或治疗后视力无好转者则判为无效。两组有效率采用百分比描述，治疗有效率的比较采用χ2检验。

结果

手术治疗组患者术后19例有效，22例无效，视力恢复有效率为46.34%。激素冲击治疗组患者治疗后8例有效，19例无效，视力恢复有效率为29.63%。将两组患者的视力恢复有效率进行比较，差异无统计学意义(χ2＝1.90，P>0.05)。在手术治疗组中，术前仅有光感至视力0.02者25例，术后有13例患者视力有所提高。其中，受伤时间在3 d以内者18例，术后11例为有效；受伤时间在3 d及以上者7例，术后2例为有效。术前无光感者共16例，术后有6例患者不同程度地恢复了部分视力；其中，受伤时间3 d以内者10例，术后4例为有效；受伤时间3 d及以上者6例，术后2例为有效。在激素冲击疗法组中，治疗前视力有光感至视力0.02者13例，治疗后视力提高5例；其中，受伤时间3 d以内就诊者为7例，治疗后3例为有效；受伤时间3 d及以上者6例，治疗后2例为有效。无光感者共14例，经激素冲击疗法治疗后，3例患者不同程度地恢复了部分视力，其中受伤时间3 d以内者10例，治疗后2例为有效；受伤时间3 d及以上者4例，治疗后1例为有效。受伤时间在3 d以内的患者共45例，治疗后27例为有效，有效率为60.0%；受伤时间3 d及以上者共23例，治疗后7例为有效，有效率为30.4%。经过χ2检验，两组有效率差异有统计学意义(χ2＝5.32，P<0.05)。说明受伤后及时治疗，可以提高手术有效率。

结论

对视神经损伤患者早期给予视神经管减压术和激素冲击治疗，均可有效促进个体的视力恢复。

关键词: 视神经管减压术, 激素冲击疗法, 视神经管骨折, 视力
Objective

To observe the effect of optic canal decompression and hormone shock therapy on visual prognosis of the patients with optic canal fracture.

Methods

The clinical data of 68 patients with optic nerve injury treated in the Department of Neurosurgery, the First Affiliated Hospital of Xinjiang Medical University from December 2010 to May 2017 were included. All were monocular damage. Among them, there were 49 males, 19 females, 38 left eyes, and 30 right eyes. The age of the patients was 21~58 years, and the average age of the patients was (35.6±3.4) years. In the cause of injury, including 31 cases of traffic injury, 22 cases of falling injury and fall injury in 15 cases; in 12 hours after injury in 22 patients, 12 ~ 24 hours were 8 cases, 15 cases of injury after 1 to 3 days of treatment, 15 cases in 4 to 7 days after injury patients in 8 cases, seventh to thirtieth days after injury patients. According to the different methods of clinical treatment, the patients were divided into surgical treatment group and hormone shock treatment group. The surgery group 41 cases, male 28 cases, female 13 cases, average age (36.1±3.8) years old, the average duration of (6.2±2.8) days, were treated with optic nerve decompression therapy; hormone impact treatment group of 27 cases, 6 cases were male, 21 were female, the average age (34.5±3.1) years old, average course (6.7±3.1) days, were treated with hormone shock therapy. The two groups of patients all observed their visual acuity and fundus on the third, seventh and 30 days after the operation or the beginning of the treatment. After surgery or after treatment, visual improvement is found to be effective. No improvement in visual acuity after surgery or after treatment is found to be invalid. The effectiveness of the two groups was described by the number and percentage of cases, and the efficiency of the treatment was compared with the chi square test.

Results

In the operation group, 19 cases were effective, 22 cases were ineffective, and the recovery rate of visual acuity was 46.34%. In the hormone shock treatment group, 8 cases were effective, 19 cases were ineffective, and the recovery rate of visual acuity was 29.63%. The visual recovery efficiency of the two groups of patients was compared. There is no statistical significance in the difference(χ2=1.90, P>0.05). In the operative group, 25 patients had light perception to 0.02 of vision before operation, and 13 cases had vision improvement after treatment. Among them, 18 cases were injured within 3 days, 11 cases were effectively recovered, 7 cases were injured for 3 days or more, and 2 cases were effectively recovered. There were 16 cases without photoperfusion before operation, 6 cases recovered to some extent after surgery, 10 cases of them were injured within 3 days, 4 cases were effectively recovered, 6 cases were injured 3 days or more, and 2 cases were effective. In the steroid therapy group, before treatment, visual acuity and visual acuity of 0.02 to light perception in 13 cases, visual acuity improved after treatment had 5 cases; the injured within 3 days of treatment in 7 cases, effective recovery of 3 cases were injured; 3 days and more than 6 cases, 2 cases were effective. A total of 14 cases were not photoreceptor. After treatment with hormone pulse therapy, 3 cases recovered some visual acuity. 10 cases were injured within 3 cases, 2 cases were effectively recovered, 4 cases were injured 3 days or more, and one case had effective recovery. A total of 45 cases were injured within 3 days. Effective recovery was achieved in 27 cases, and the effective rate was 60.0%. There were 23 cases who had been injured for 3 days or more. Effective recovery was found in 7 cases, and the effective rate was 30.4%. After the chi square test, the difference between the two groups was statistically significant (χ2=5.32, P<0.05). It shows that timely treatment after injury can improve the efficiency of the operation.

Conclusion

Early optic canal decompression and hormone shock therapy for patients with optic nerve injury can effectively promote the recovery of the individual′s visual acuity.

Key words: Optic canal decompression, Hormone therapy, Optic canal fracture, Vision
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