机械性眼外伤临床特征及眼外伤评分应用

Clinical characteristics of mechanical ocular injury and application of ocular trauma score

目的总结机械性眼外伤住院患者的临床特征，并分析眼外伤评分（OTS）在患者终视力预后评估中的作用。方法回顾性系列病例研究。对天津医科大学总医院眼科2009年1月至2010年12月住院治疗的162例（168只眼）机械性眼外伤患者的住院资料进行分析，包括患者的眼别、性别、年龄、就诊时间、致伤原因、眼外伤分类、伤眼最初视力和随诊的终视力（最佳矫正视力）等。对所有眼外伤患者进行视功能测定、裂隙灯显微镜及检眼镜的检查，还包括超声活体显微镜等辅助检查，并应用眼外伤评分对其预后进行评估。外伤类型在就诊时间、住院天数等组间比较，采用原始数据两样本比较的秩和检验；初视力与终视力以及终视力与OTS的相关性分析，采用秩相关分析；年龄、致伤原因、外伤类型及初视力与终视力等分类变量资料的统计推断，采用卡方检验；两性别发病年龄的比较，采用z检验。结果机械性眼外伤168只眼中开放性眼外伤106只眼，闭合性眼外伤62只眼。男性患者140例（85．71％），女性患者22例（14．29％）。开放性眼外伤和闭合性眼外伤患者的就诊时间中位数分别为外伤后5h及10h，差异有统计学意义（Z=-2．547，P=0．011）。机械性眼外伤高发人群为青年（≤44岁）100只眼（59．52％），其次为中年（45～59岁）46只眼（27．38％），老年（60岁及以上）22只眼（13．10％）。导致眼外伤的原因以工作生产为主，共70例（41．47％），且77％（54／70）为开放性眼外伤。闭合性眼外伤的初视力及终视力均好于开放性眼外伤，差异均有统计学意义（χ2=37．847，P=0．000；χ2=44．428，P=0．000）。所有外伤眼终视力与初视力呈正相关（r=0．858，P=0．000）。通过OTS计算后，患者的终视力与总评分（r=0．870，P=0．000）及OTS（r=0．869，P=0．000）均存在正相关。结论本组机械性眼外伤患者男性多于女性，以开放性眼外伤为主，其就诊时间早于闭合性眼外伤，高发人群为青年，致伤原因以工作生产为主，闭合性眼外伤的初视力及终视力均好于开放性眼外伤。OTS分值可为眼外伤患者提供重要的预后信息。

Objective To summarize clinical characteristics of mechanical ocular injury and to analyze the role of ocular trauma score （OTS） in the estimation of final visual acuity. Methods All cases of ocular trauma admitted to the Department of Ophthalmology from January 2009 to December 2010 were retrospectively reviewed. Data extracted included laterality of the injured eye, gender, age, presenting time, cause, ocular trauma classification, initial and final visual acuity. These injuries were classified by ocular trauma classification system （OTCS）. We also used the OTS in evaluating the final visual outcome. Comparisons between groups for discontinuous variables were analyzed using rank-sum test. Rank correlation was used in analysis between initial visual acuity and final visual acuity or between final visual acuity and OTS. Chi-square test was used to analyze variables, such as age, cause, type and visual acuity. Comparison of ages between male and female was analyzed by using t-test. Results Of the 168 eyes, there were 106 open globe injury （OGI） and 62 closed globe injury （CGI）. There were 140 males （85.71%） and 22 females （ 14.29% ）. Presenting time median of OGI and CGI was 5 h and 10 h respectively, and there was significant difference between these two different injuries （ Z =- 2. 547, P = 0.011 ）. The high-risk age group was the young age group （100 eyes, 59.52% ）, vs. the middle age group （46 eyes, 27.38% ） and the elder age group （22 eyes, 13.10% ）. Occupation-related injury （70 eyes） was the most common cause and mainly resulted in OGI （54/70）. Initial and final visual acuities in CGI were better than those of OGI （ χ2 = 37. 847, P = 0.000 ;χ2 = 44. 428, P = 0. 000）. Initial visual acuity was correlated with final visual acuity （r = 0. 858, P = 0. 000）. Final visual acuity was significantly correlated with total score （r = 0.870, P = 0.000） and OTS （ r = 0. 869, P = 0. 000）. Conclusions In this group of mechanical ocular trauma patients, male is more common than the female. Main type of injury is OGI and presenting time of OGI is earlier than that of CGI. The high-risk age group is the young. Main cause of injury is occupation-related injury. Initial and final visual acuities in CGI are better than those in OGI. OTS calculated at initial examination may be a useful parameter for the estimation of prognosis.