非火器类异物致眶颅贯通伤的救治（附20例报告）

Treatment of orbitocranial penetrating injuries caused by non-firearm foreign bodies： a report of 20 cases

目的 通过总结20例眶颅贯通伤患者的临床资料,为眶颅贯通伤的处理提供数据支持与经验.方法 回顾性分析2004年1月至2014年1月复旦大学附属华山医院神经外科收治的20例非火器类异物所致的眶颅贯通伤患者.患者的临床资料包括年龄、性别、入院时格拉斯哥昏迷评分（GCS）、受伤至手术的时间、异物种类、手术方式、受伤类型及范围、住院时间和视敏度,以及影响预后的主要并发症.随访时间为3个月至2年.以格拉斯哥预后分级（GOS）评估患者预后.结果 眶颅贯通伤患者共20例,其中男18例,女2例;年龄9～66岁,平均31.7岁.GCS评分15 ～ 14分19例（95％）,12分1例（5％）.所有损伤均为意外事故导致,其中金属异物11例,木质异物4例,竹制品3例,塑料异物2例.CT检查结果示8例异物眶内入口位于内眦,8例位于下眼睑,2例位于外眦,2例位于上眼睑.10例异物由眶上裂进入颅内,8例颅内入口位于蝶骨大翼,2例颅内入口位于前床突.5例患者经双额底入路、15例经翼点入路手术.5例患者并发颅内感染,最终痊愈出院.GOS分级Ⅴ级18例,Ⅳ级2例.结论 对于非火器类眶颅贯通伤,早期发现颅内损伤和正确的手术治疗将显著改善该类患者的预后.

Objective To provide data support and experiences for the management of orbitocranial penetrating injuries by summarizing 20 patients with orbitocranial penetrating injury.Methods Twenty patients with orbitocranial penetrating injury caused by non-firearm foreign bodies admitted to the Nerve Trauma Center,Huashan Hospital,Fudan University from January 2004 to January 2014 were analyzed retrospectively.The clinical data of the patients included age,sex,Glasgow coma scale （GCS） on admission,time from injury to surgery,foreign body type,surgical approach,type of injury and scope,hospitalization time and visual acuity,as well as major complications affecting prognosis.They were followed up from 3 months to 2 years.The prognosis of patients was assessed by the Glasgow outcome scale （GOS）.Results There are 18 males and 2 females,their age ranged from 9 to 66 years old （mean 31.7 years）.GCS was 15 ～ 14 in 19 patients（95%）,12 in 1 patients （5%）.All the injuries were caused by accidents,11 of them were metallic foreign bodies,4 were wooden foreign bodies,3 were bamboo products,and 2 were plastic foreign bodies.CT findings revealed that the orbital entrances of 8 foreign bodies were located at the inner canthi,8 were located at the lower eyelids,2 were located at outer canthi,and 2 were located at the upper eyelids.Of the 20 patients,10 foreign bodies entered from superior orbital fissure into skull.The 8 intracranial entries were located at the great wing of sphenoid,and 2 were located at anterior clinoid process.Five patients were operated via bifrontal transbasal approach and 15 were operated via pterional approach.Five patients complicated with intracranial infection and they eventually recovered and discharged.The GOS grade Ⅴ was in 18 cases and grade Ⅳwas in 2 cases.Conclusions The early detection of intracranial injury and correct surgical treatment will significantly improve the prognosis of the patients with non-firearm orbitocranial penetrating injuries.