经筛蝶视神经管减压术治疗外伤性视神经病变的疗效及影响因素分析

doi:10.3877/cma.j.issn.2095-9141.2021.03.006

中华神经创伤外科电子杂志 ›› 2021, Vol. 07 ›› Issue (03) : 151 -155. doi: 10.3877/cma.j.issn.2095-9141.2021.03.006

颅脑与脊髓损伤

经筛蝶视神经管减压术治疗外伤性视神经病变的疗效及影响因素分析

李勇刚¹, 马峻¹, 雪亮¹^,^†(

), 苏少波¹, 张川¹, 曹艺耀¹, 赵子龙¹, 江荣才¹, 岳树源¹

^1. 300052　天津，天津医科大学总医院神经外科

收稿日期:2021-03-04 出版日期:2021-06-15
通信作者: 雪亮

Analysis of therapeutic efficacy and influencing factors of transethmoidal-spheniodal optic nerve decompression for traumatic optic neuropathy

Yonggang Li¹, Jun Ma¹, Liang Xue¹^,^†(), Shaobo Su¹, Chuan Zhang¹, Yiyao Cao¹, Zilong Zhao¹, Rongcai Jiang¹, Shuyuan Yue¹

^1. Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 30052, China

Received:2021-03-04 Published:2021-06-15
Corresponding author: Liang Xue

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目的

探讨经筛蝶入路视神经管减压术在外伤性视神经病变（TON）中的治疗效果及影响预后的因素。

方法

回顾性分析天津医科大学总医院神经外科自2008年1月至2019年12月收治的49例TON患者。通过术后视力恢复情况及相关并发症出现情况，对经筛蝶入路视神经管减压术的临床疗效进行评估，并分析影响预后的因素。

结果

49例患者均实施经筛蝶入路视神经管减压术，术后无严重并发症，总体有效率为53.1%。通过单因素分析发现，患者术前视力有无光反应、创伤至手术间隔时间与术后视力改善情况密切相关（P=0.011、0.016）。而患者年龄、意识状态、视神经管骨折程度、不同手术入路及是否伴有脑脊液漏与预后无明显相关性。

结论

TON患者通过经筛蝶入路行视神经管减压术，可改善伤后患者视力，并且对于术前有光感和创伤后尽早手术的患者，术后可能会取得更好的治疗效果。

关键词: 外伤性视神经病变, 视神经管减压术, 经筛蝶入路

Objective

To investigate the therapeutic effect and prognostic factors of optic nerve decompression via ethmoid sphenoid approach in traumatic optic neuropathy (TON).

Methods

A total of 49 patients with TON in Neurosurgery Department of Tianjin Medical University General Hospital from January 2008 to December 2019 were retrospectively analyzed. Based on the postoperative visual acuity recovery and related complications, the clinical efficacy of ethmoid sphenoidal approach for optic nerve decompression was evaluated, and the factors affecting the prognosis were analyzed.

Results

All 49 patients were treated with the decompression of optic nerve tube through sieve butterfly approach, and there’s no serious complications after surgery. The total effective rate was 53.1%. Through single factor analysis, it was found that optical preoperative visual response, trauma to surgical interval are closely related to postoperative vision improvement (P=0.011, 0.016). The age, consciousness, degree of optic nerve canal fracture, different surgical approaches and CSF leakage were not significantly correlated with prognosis.

Conclusion

The visual acuity of patients with TON can be improved by optic nerve decompression through ethmoid sphenoidal approach, and the patients with preoperative light perception and early post-trauma surgery may obtain better treatment effect after operation.

Key words: Traumatic optic neuropathy, Optic nerve decompression, Transethmoidal-spheniodal appoach

图1 外伤性视神经病变患者术前术后视神经管CT图

表1 预后良好组与预后不良组外伤性视神经病变患者的相关资料比较[例（%）]

因素		例数	预后良好(n=26)	预后不良(n=23)	χ²值	P值	RR	95%CI
年龄					0.000	0.990	1.007	0.310~3.274
	<40岁	32	17(53.1)	15(46.9)
	≥40岁	17	9(52.9)	8(47.1)
术前视力					5.193	0.011	2.211	1.585~3.083
	有光反应	7	7(100.0)	0(0.0)
	无光反应	42	19(45.2)	23(54.8)
受伤至手术时间					5.815	0.016	4.219	1.276~13.948
	<3 d	26	18(69.2)	8(30.8)
	≥3 d	23	8(34.8)	15(65.2)
视神经管骨折情况					4.114	0.561
	无	2	0(0)	2(100.0)
	单发骨折	16	11(68.8)	5(31.2)
	多发骨折	31	15(48.4)	16(51.6)
损伤类型					0.000	1.000	0.870	0.157~4.802
	直接损伤	6	3(50.0)	3(50.0)
	间接损伤	43	23(53.5)	20(46.5)
意识丧失					0.031	0.861	0.620	0.123~3.117
	有	7	3(42.9)	4(57.1)
	无	42	23(54.8)	19(45.2)
不同术式					0.246	0.774	1.333	0.427~4.162
	经鼻经筛蝶入路	21	12(57.1)	9(42.9)
	经鼻旁经筛蝶入路	28	14(50.0)	14(50.0)
脑脊液漏					0.641	0.423	4.000	0.413~38.702
	有	5	4(80.0)	1(20.0)
	无	44	22(50.0)	22(50.0)

表1 预后良好组与预后不良组外伤性视神经病变患者的相关资料比较[例（%）]

因素		例数	预后良好(n=26)	预后不良(n=23)	χ²值	P值	RR	95%CI
年龄					0.000	0.990	1.007	0.310~3.274
	<40岁	32	17(53.1)	15(46.9)
	≥40岁	17	9(52.9)	8(47.1)
术前视力					5.193	0.011	2.211	1.585~3.083
	有光反应	7	7(100.0)	0(0.0)
	无光反应	42	19(45.2)	23(54.8)
受伤至手术时间					5.815	0.016	4.219	1.276~13.948
	<3 d	26	18(69.2)	8(30.8)
	≥3 d	23	8(34.8)	15(65.2)
视神经管骨折情况					4.114	0.561
	无	2	0(0)	2(100.0)
	单发骨折	16	11(68.8)	5(31.2)
	多发骨折	31	15(48.4)	16(51.6)
损伤类型					0.000	1.000	0.870	0.157~4.802
	直接损伤	6	3(50.0)	3(50.0)
	间接损伤	43	23(53.5)	20(46.5)
意识丧失					0.031	0.861	0.620	0.123~3.117
	有	7	3(42.9)	4(57.1)
	无	42	23(54.8)	19(45.2)
不同术式					0.246	0.774	1.333	0.427~4.162
	经鼻经筛蝶入路	21	12(57.1)	9(42.9)
	经鼻旁经筛蝶入路	28	14(50.0)	14(50.0)
脑脊液漏					0.641	0.423	4.000	0.413~38.702
	有	5	4(80.0)	1(20.0)
	无	44	22(50.0)	22(50.0)

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