颅脑外伤合并眼外伤患者临床分析

Clinical analysis of patients with brain injury in conjunction with ocular injury

目的分析颅脑外伤合并眼外伤患者的眼部损伤状况、致伤原因及与不同性质脑外伤的相关性。方法回顾性分析神经外科收治首次就诊的脑外伤1036例，其中合并眼外伤者46例，分析其眼损伤部位、外伤原因、与不同性质脑损伤的相关性、治疗方法和对视功能的影响。结果颅脑外伤合并眼外伤46例（47只眼）。男40例，占86．96％；女6例，占13．04％。年龄15—72岁，平均（40．11±11．89）岁。合并的眼部损伤包括：眶壁骨折13例，占28．26％；眼睑复杂裂伤11例，占23．91％；眼球穿孔及破裂伤10例（11只眼），占21．74％；视神经损伤7例，占15．22％；其他5例，占10．87％。致伤原因是：交通伤28例（60．87％），暴力伤7例（15．22％），爆炸伤5例（10．87％），其他6例（13．04％）。10例（11只眼）开放性眼球外伤中8例（8只眼）行眼球摘除术，2例（3只眼）保存了视功能。7例视神经挫伤，3例行经筛窦视神经管减压术，视力提高，4例无手术指征者给予药物治疗，1例视力提高。合并眶壁骨折经CT检查确诊，后期手术修复，对视功能影响较轻。2例合并眼肌麻痹者，诊断相对滞后，药物治疗观察期内复视未能恢复。结论颅脑外伤合并眼外伤的患者在坚持抢救生命的前提下，尽早处理严重的眼球破裂及穿孔伤和视神经挫伤，力求挽救视功能。

Objective To investigate the condition of eye injury, the causes, the correlation with different kinds of brain trauma of traumatic brain injury combined with ocular injury. Methods In neurosurgery department, 1036 patients were retrospectively analyzed. These patients had traumatic brain injuries in their first visiting. Forty-six patients out of 1036 had craniocerebral trauma combined with complex ocular injuries. These patients were analyzed to find the injured part of the eye, the causes, the relation with traumatic brain injuries, the treatment of ocular injuries and the recovery of their visual function. Results According to the medical records, 40 patients of these 46 patients were men, accounting for 86.96%. Six patients were female, accounting for 13.04%. And their ages were from 15 to 72 years old with an average of （40. 11 ~ ll. 89） years old. These patients included 13 cases of orbital wall fracture accounting for 28.26%, 11 cases of eyelid complex laceration accounting for 23.91%, 10 cases （ 11 eyes） of eyeball rupture accounting for 21.74%, 7 cases of optic nerve injury accounting for 15.22% and 5 cases of other ocular injuries accounting for 10.87%. The causes for the injuries were traffic accidents in 28 cases （60.87%）, violence in 7 cases （ 15.22% ）, explosion in 5 cases （ 10. 87% ） and others in 6 cases （ 13.04% ）. The treatments were as follows. Enucleation was done for 8 eyes out of 11 eyes with open ocular trauma due to the serious damage. Screening optic canal decompression was carried out for 3 patients with clear optic canal fracture in emergent treatment, and the vision was improved after the operation. For the other 4 patients, glucocorticoid impact therapy was carried out and only 1 patient had vision improvement. It was relatively easy to diagnose traumatic brain injuries combined with orbital wall fracture by CT and most of this kind of damages can be repaired by the subsequent surgery. For 2 patients with external ophthalmoplegia, the function of ocular muscle was partially recovered while diplopia remained. Conclusion For patients with traumatic brain injuries combined with ocular injuries, the principle of treatment should be on the premise of saving lives, meanwhile, serious eyeball rupture, perforation and optic nerve contusion should be treated as soon as possible to save the visual function.