额外侧入路视神经管减压术在外伤性失明病人中的应用

Application of optic canal decompression via frontolateral approach in blind patients with traumatic optic neuropathy

目的探讨经额外侧入路视神经管减压术治疗外伤性视神经损伤后失明病人的效果。方法回顾性分析13例外伤性视神经损伤病人(病眼14只)的临床资料,术前病眼视力均为无光感,均采用经额外侧入路视神经管减压术治疗,术后定期随诊。以视力提升2个级别及以上为有效,视力提升1个级别为改善,视力一直无光感为无效。结果术后1周内视力恢复情况:达眼前指数3眼,眼前指动1眼,光感2眼,无光感8眼。术后1个月视力恢复情况:达辨识字体2眼,眼前指数4眼,眼前指动1眼,光感1眼,无光感6眼。远期视力达有效7眼,改善1眼,均在损伤后9 d内行手术治疗;无效6眼,在损伤后9 d内手术2眼,超过9 d行手术治疗4眼。结论外伤性视神经损伤致失明病人保守治疗无改善,应尽快手术治疗,经额外侧入路视神经管减压术是有效的治疗方法。

Objective To explore the effect of optic canal decompression via frontolateral approach for blind patients with traumatic optic neuropathy. Methods Clinical data of 13 patients（ 14 affected eyes） with traumatic optic neuropathy were analyzed retrospectively. The preoperative visual acuity was in no light perception in all the patients, who were treated by optic canal decompression via frontolateral approach and regularly followed up after the operation. The visual acuity increase of 2 level and above was considered as effective, increase of 1 level as meliorative and no change as invalid. Results Recovery of visual acuity within 1week after the operation： front index was achieved in 3 eyes, front thumb in 1, light perception in 2 and no light perception in 8.Recovery of visual acuity within 1 month after the operation： front identification was achieved in 2 eyes, front index in 4, front thumb in1, light perception in 1 and no light perception in 6. The effective surgery was obtained in 7 eyes and meliorative in 1 according to the long-term vision, and all surgeries were completed within 9 d after injury. The invalid surgery was seen in 6 eyes, 2 of which underwent surgery within 9 d after injury and 4 over 9 d after injury. Conclusion Optic canal decompression via frontolateral approach is an effective method for blind patients with traumatic optic neuropathy, and the operation should be performed as soon as possible.