外伤性视神经病变不同治疗方法的临床研究
摘要
目的:比较外伤性视神经病变患者经鼻内镜下视神经管减压术与单纯药物治疗的临床疗效,并探讨视力预后的影响因素。
方法:回顾性研究1999年8月至2008年1月我院外伤性视神经病变患者临床资料。88例患者被分为鼻内镜手术组(42例)和单纯药物治疗组(46例),对比两者之间疗效差异;根据受伤至手术的间隔时间不同,将手术组分为伤后7天以内手术组与7天以后手术组,比较疗效差异;以性别、年龄、眼别、伤后有无光感、有无骨折、昏迷史、受伤原因、治疗方式8个临床观察因素作为自变量(X),疗效作为因变量,进行非条件Logistic回归分析,研究眼视力预后的影响因素。
结果:
1.伤后无光感患者中,药物组与手术组比较,两者之间差别有统计学意义(p=0.040),手术疗效优于药物治疗。
2.伤后有光感患者中,药物组与手术组比较,两者之间差别有统计学意义(p=0.030),手术疗效优于药物治疗。
3.接受手术患者中,伤后7天以内手术组与7天以后手术组比较,两者之间差别有统计学意义(p=0.029),7天以内手术组优于7天以后手术组。
4.对变量进行非条件Logistic回归分析(x~2=20.333,p=0.000),筛选出伤后无光感(p=0.010)、有昏迷史(p=0.010)是影响预后的危险因素,手术治疗是保护视力的有力措施(p=0.006)。
结论:
1.无论外伤性视神经病变患者伤后有无光感,联合手术治疗的疗效均优于单纯药物治疗。
2.手术时间以伤后7天以内为佳,但即使受伤时间较长,也不应轻易放弃。
3.伤后无光感、有昏迷史是影响眼视力预后的危险因素,手术治疗是保护视力的有力措施。
Objective: This paper compares the curative effect of endoscopic optic nerve decompression (EOND) and simple medical treatment and analyzes risk factors in traumatic optic neuropathy(TON).
Methods: This paper retrospectively reviews patients with TON from August 1999 to January 2008. The 88 patients(88 eyes)with TON are divided into two groups : EOND (42 eyes)and drug(46eyes) andcurative effects of the two groups are compared. The best operationtime can be sought, based on the analysis of operations within or after 7 days since injures.This paper, regarding sex, age, eyes,visual acuity of no light perception(NLP), fracture, coma and injure reasonas independent variable (X), and the curative effects as dependent variable(Y), carries on nonconditional logistic regressionanalysis and studies the risk factors on traumatic optic neuropathy.
Results:
1. Among the patients with no light perception, there is statistic difference (p =0.044) between the surgical group and the drug group. The curative effect of operation is much better.
2. Among the patients with light perception, the statistic difference between the two group (p =0.030). The effect of the surgery is better.
3. According to the operation periods, there is difference (p = 0.029) between injured patients operated within 7 days and after 7days. It shows --the sooner, the better.
4. Nonconditional logistic regression analysis( x~2=20.333, p =0.000)confirms that NLP ( p =0.010), coma ( p =0.010) are risk factors affecting traumatic optic neuropathy. Early surgical treatment after trauma could protect visual acuity in traumatic optic neuropathy (p =0.006).
Conclusion:
1. Therapeutic effect of surgical treatment, on patients both with and without light perception, is better than that of medicationtherapy.
2. Therapeutic effect of Patients in operation within 7 days is better than that after 7 days.
3. NLP, coma are risk factors affecting traumatic optic neuropathy. Early surgical treatment after trauma could effectively protectvisual acuity.
方法:回顾性研究1999年8月至2008年1月我院外伤性视神经病变患者临床资料。88例患者被分为鼻内镜手术组(42例)和单纯药物治疗组(46例),对比两者之间疗效差异;根据受伤至手术的间隔时间不同,将手术组分为伤后7天以内手术组与7天以后手术组,比较疗效差异;以性别、年龄、眼别、伤后有无光感、有无骨折、昏迷史、受伤原因、治疗方式8个临床观察因素作为自变量(X),疗效作为因变量,进行非条件Logistic回归分析,研究眼视力预后的影响因素。
结果:
1.伤后无光感患者中,药物组与手术组比较,两者之间差别有统计学意义(p=0.040),手术疗效优于药物治疗。
2.伤后有光感患者中,药物组与手术组比较,两者之间差别有统计学意义(p=0.030),手术疗效优于药物治疗。
3.接受手术患者中,伤后7天以内手术组与7天以后手术组比较,两者之间差别有统计学意义(p=0.029),7天以内手术组优于7天以后手术组。
4.对变量进行非条件Logistic回归分析(x~2=20.333,p=0.000),筛选出伤后无光感(p=0.010)、有昏迷史(p=0.010)是影响预后的危险因素,手术治疗是保护视力的有力措施(p=0.006)。
结论:
1.无论外伤性视神经病变患者伤后有无光感,联合手术治疗的疗效均优于单纯药物治疗。
2.手术时间以伤后7天以内为佳,但即使受伤时间较长,也不应轻易放弃。
3.伤后无光感、有昏迷史是影响眼视力预后的危险因素,手术治疗是保护视力的有力措施。
Objective: This paper compares the curative effect of endoscopic optic nerve decompression (EOND) and simple medical treatment and analyzes risk factors in traumatic optic neuropathy(TON).
Methods: This paper retrospectively reviews patients with TON from August 1999 to January 2008. The 88 patients(88 eyes)with TON are divided into two groups : EOND (42 eyes)and drug(46eyes) andcurative effects of the two groups are compared. The best operationtime can be sought, based on the analysis of operations within or after 7 days since injures.This paper, regarding sex, age, eyes,visual acuity of no light perception(NLP), fracture, coma and injure reasonas independent variable (X), and the curative effects as dependent variable(Y), carries on nonconditional logistic regressionanalysis and studies the risk factors on traumatic optic neuropathy.
Results:
1. Among the patients with no light perception, there is statistic difference (p =0.044) between the surgical group and the drug group. The curative effect of operation is much better.
2. Among the patients with light perception, the statistic difference between the two group (p =0.030). The effect of the surgery is better.
3. According to the operation periods, there is difference (p = 0.029) between injured patients operated within 7 days and after 7days. It shows --the sooner, the better.
4. Nonconditional logistic regression analysis( x~2=20.333, p =0.000)confirms that NLP ( p =0.010), coma ( p =0.010) are risk factors affecting traumatic optic neuropathy. Early surgical treatment after trauma could protect visual acuity in traumatic optic neuropathy (p =0.006).
Conclusion:
1. Therapeutic effect of surgical treatment, on patients both with and without light perception, is better than that of medicationtherapy.
2. Therapeutic effect of Patients in operation within 7 days is better than that after 7 days.
3. NLP, coma are risk factors affecting traumatic optic neuropathy. Early surgical treatment after trauma could effectively protectvisual acuity.
引文
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[3] Kountakis SE, Maillard AA, Ei-Harazi SM, et al.Endoscopic optic nerve decompression for traumatic blindness.Otolaryngol Head Neck Surg, 2000, 123(1):34—37
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