神经内镜经鼻视神经管减压治疗外伤性视神经病变的疗效及预后因素分析(附21例报告)

doi:10.19854/j.cnki.1008-2425.2025.06.0002

摘要/Abstract

摘要： 目的探讨神经内镜经鼻视神经管减压治疗外伤性视神经病变(TON)的临床疗效,并分析影响患者视力预后的相关因素。方法回顾性分析2022年7月至2025年4月收治的21例TON患者的临床资料。所有患者均接受神经内镜经鼻视神经管减压术。记录患者基线资料、受伤机制、术前视力、手术时机、影像学表现及随访结果。根据术后视力是否改善分为有效组(n=11)和无效组(n=10),采用单因素及多因素Logistic回归分析预后因素。结果 21例患者术后视力总体改善率为52.4%(11/21)。单因素分析显示,有效组从受伤至手术的时间短于无效组(2.7±3.2天 vs 5.4±4.2天,P=0.075),但差异未达统计学意义;两组在性别、年龄、受伤机制、骨折类型等因素上差异无统计学意义(P>0.05)。多因素分析显示,早期手术(≤7天)是视力改善的独立保护因素(OR=0.135,95%CI:0.024~0.747),而术前无光感(NLP)是独立危险因素(OR=18.288,95%CI:1.636~204.424)。术前视力为指数(CF)的患者有效率最高,但部分NLP患者术后视力也能获得改善。结论神经内镜下视神经管减压术是治疗TON的有效方法。伤后早期(≤7天)手术和术前仍存留光感是获得良好预后的关键因素。

关键词: 外伤性视神经病变, 神经内镜, 视神经管减压术, 预后因素, 视力恢复

Abstract: Objective To evaluate the efficacy of neuroendoscopic optic canal decompression(NOCD) in the treatment of traumatic optic neuropathy(TON) and to analyze the factors influencing visual prognosis. Methods A retrospective analysis was conducted on 21 TON patients who underwent NOCD between July 2022 and April 2025.Patients were divided into an effective group(n=11) and an ineffective group(n=10) based on postoperative visual improvement.Univariate and multivariate logistic regression analyses were performed to identify prognostic factors. Results The overall visual improvement rate was 52.4%.Univariate analysis showed that the time from injury to surgery was shorter in the effective group(2.7±3.2 days vs.5.4±4.2 days,P=0.075),but the difference was not statistically significant.Multivariate analysis identified early surgery(≤7 days) as a protective factor(OR=0.135,95% CI:0.024~0.747) and no light perception(NLP) as a risk factor(OR=18.288,95% CI:1.636~204.424).Patients with counting fingers(CF) vision preoperatively had the highest improvement rate,while some NLP patients also benefited from the surgery. Conclusion NOCD is effective for TON.Early intervention and preserved preoperative light perception are key factors for better visual outcomes.

Key words: Traumatic optic neuropathy, Neuroendoscopy, Optic canal decompression, Prognostic factors, Visual recovery

中图分类号:

R651

程旭峰, 王飞, 叶成坤, 陈海宁, 王宣之. 神经内镜经鼻视神经管减压治疗外伤性视神经病变的疗效及预后因素分析(附21例报告)[J]. 立体定向和功能性神经外科杂志, 2025, 38(6): 327-332.

Cheng Xufeng, Wang Fei, Ye Chengkun, Chen Haining, Wang Xuanzhi. Efficacy and prognostic factors analysis of neuroendoscopic optic canal decompression for traumatic optic neuropathy:A report of 21 cases[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2025, 38(6): 327-332.

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