鼻内镜下视神经减压术治疗外伤性视力完全丧失的预后相关因素分析

Analysis of prognostic factors in endoscopic optic nerve decompression in traumatic blindness

目的探讨鼻内镜下视神经减压术对外伤性视力完全丧失的疗效,并评估其预后相关因素。方法回顾性分析85例外伤性视力完全丧失患者的临床资料,通过单因素分析和Logistic回归分析来评估其潜在的预后相关因素。结果鼻内镜下视神经减压术后,患者总体视力提高44.7%(38/85)。单因素分析显示:筛窦和(或)蝶窦内积血是视力改善的负性因素。而Logistic回归分析显示:外伤到手术的时间超过3 d、筛窦和(或)蝶窦内积血与外伤性视力丧失的预后呈负性相关。结论筛窦和(或)蝶窦内积血、外伤到手术的时间超过3 d是外伤性视力丧失视力恢复的危险因素。视力完全丧失的患者伤后3 d内如能实施手术,视力可能得以较好改善。

Objective To investigate the therapeutic efficacy of endoscopic optic nerve decompression in the treatment of traumatic blindness and to evaluate the relevant prognostic factors. Methods Clinical data of 85 cases with traumatic blindness and received endoscopic optic nerve decompression was analyzed retrospectively. Univariate analysis and multiple logistic regression analysis were performed to evaluate the potential prognostic factors. Results After endoscopic optic nerve decompression, the vision acuity got improved in 38 cases with an effective rate of 44.7% （38/85）. Univariate analysis indicated that hemorrhage within the ethmoid and/or sphenoid sinus was significantly associated with unrecovered visual acuity. However, multiple logistic regression analysis identified that an interval from injury to operation of more than 3 days, and hemorrhage within the ethmoid and/or sphenoid sinus were negatively correlated with the therapeutic effect. Conclusions Hemorrhage within the ethmoid and/or sphenoid sinus and an interval from injury to operation of more than 3 days are the risk factors in the visual prognosis of traumatic blindness. Surgical treatment within 3 days after injury may facilitate the improvement of vision acuity in patients with total blindness.