本文選題：視路 + 視交叉��； 參考：《吉林大學(xué)》2011年碩士論文

【摘要】：目的: 外傷性視交叉后段視路病變在臨床較為少見,常合并有顱底骨折或顱內(nèi)出血,早期診斷比較困難,本文回顧性分析了解放軍總醫(yī)院近5年就診的外傷性后視路病變患者的臨床資料,分析其病因、臨床表現(xiàn)、影像學(xué)特點及預(yù)后,做到早期診斷、早期治療,對保護視功能具有重要意義。 方法: 選擇從2006年1月至2010年12月就診于解放軍總醫(yī)院的顱腦外傷患者,共65人,對其相關(guān)因素進行分析,包括患者的一般情況(性別、年齡),受傷原因,損傷部位,視野改變類型,影像學(xué)表現(xiàn)及治療預(yù)后。上述各種數(shù)據(jù)統(tǒng)計分析后得出外傷性后視路病變的好發(fā)年齡、性別,受傷主要原因,常見視野改變類型與影像學(xué)特點,用藥后視野改善率與病程的相關(guān)性。 結(jié)果: 1、外傷性后視路病變以31～40歲患者居多,占患病人數(shù)的46.2 %,其中,男性患者較多,43例,占患病人數(shù)的66.2 %,女性患者22例,占患病人數(shù)的33.8 %,男女患者性別構(gòu)成比例為1.9:1。 2、視野缺損情況:非重疊性同向偏盲35例(53.8 %),重疊性同向偏盲21例(32.3 %),皮質(zhì)盲8例(12.3 %),雙眼同向偏盲性中心暗點1例(1.6 %)。65例病例中,14例(21.5 %)黃斑回避。 3、視野缺損與損傷部位的關(guān)系:視束損傷占5例(7.7 %),視野表現(xiàn)為非重疊性同向偏盲;外側(cè)膝狀體損傷未見;視放射損傷占11例(16.9 %),6例(9.2 %)表現(xiàn)為非重疊性同向偏盲,5例(7.7 %)為重疊性同向偏盲,其中3例(4.6 %)表現(xiàn)為黃斑回避;枕葉損傷占20例(30.8 %),4例(6.2 %)為非重疊性同向偏盲,9例(13.9 %)為重疊性同向偏盲,6例(9.2 %)為皮質(zhì)盲,1例(1.5 %)為同向偏盲性中心暗點,其中8例(12.5%)表現(xiàn)為黃斑回避;多發(fā)損傷占29例(44.6 %),20例(30.8 %)為非重疊性同向偏盲,7例(10.8 %)為重疊性同向偏盲,2例(3.0%)為皮質(zhì)盲,其中黃斑回避3例(4.6 %)。 4、用藥后視野改善與病程的關(guān)系:65例患者根據(jù)病程時間長短分為4組,分別計算各組用藥后視野改善的發(fā)生率。結(jié)果顯示:第一組:病程時間≤1個月,用藥后視野改善19例(29.2 %),未改善2例(3.1 %);第二組:病程時間1、≤3個月,用藥后視野改善15例(23.1 %),未改善3例(4.6 %);第三組:病程時間3、≤6個月,用藥后視野改善7例(10.8 %),未改善8例(12.3 %);第四組:病程時間6個月,用藥后視野改善5例(7.7 %),未改善6例(9.2 %)。總計46例(70.8 %)視野改善,19例(29.2 %)視野未改善。 第一組和第二組之間比較,差異無統(tǒng)計學(xué)意義(P 0.05),第二組和第三組之間比較,差異有統(tǒng)計學(xué)意義(χ2=3.438,P 0.05),第三組和第四組之間比較,差異無統(tǒng)計學(xué)意義(P 0.05)。病程3個月以內(nèi)視野改善與大于3個月之間的比較,差異有統(tǒng)計學(xué)意義(χ2=10.787,P 0.05)。 結(jié)論: 1大多數(shù)顱腦外傷導(dǎo)致的視交叉后段視路病變以31～40歲的年輕男性多見,誘因多見于車禍傷。 2外傷性視交叉后段視路病變較易導(dǎo)致患者視野的損害,患者可出現(xiàn)不同類型的視野改變,其中以非重疊性同向偏盲多見。 3早期給予營養(yǎng)神經(jīng)、改善微循環(huán)的治療,對于外傷性視交叉后段視路病變造成的視野缺損的恢復(fù)具有積極作用,并且3個月內(nèi)給予相應(yīng)藥物治療后視野改善可能性較大。
[Abstract]:Objective:
Traumatic posterior optic interasiasa optic lesion is rare in clinic. It is often complicated with skull base fracture or intracranial hemorrhage. Early diagnosis is difficult. In this paper, the clinical data of the patients with traumatic posterior optic pathway in the General Hospital of PLA in recent 5 years were analyzed retrospectively, and the etiology, clinical manifestation, imaging features and prognosis were analyzed, and early diagnosis was done. Early treatment is of great importance for the protection of visual function.
Method:
A total of 65 patients were selected from January 2006 to December 2010 at the General Hospital of PLA General Hospital. The related factors were analyzed, including the general situation (sex, age), the cause of injury, the site of injury, the type of visual field change, the imaging manifestation and the prognosis of treatment. The age, gender, main causes of injury, common visual field change type and imaging characteristics, and the correlation between visual field improvement rate and the course of disease were discussed.
Result:
1, the majority of the patients with traumatic posterior vision were 31~40 years old, accounting for 46.2% of the number of patients. Among them, there were more male patients, 43 cases, 66.2% of the number of patients, 22 cases of women, 33.8% of the number of patients, and the sex ratio of 1.9:1. for men and women was 1.9:1..
2, visual field defect: non overlapping homonymous blind 35 cases (53.8%), overlapping homonymous blindness in 21 (32.3%), cortical blindness (12.3%), 1 (1.6%).65 cases, and 14 cases (21.5%) macular avoidance in both binocular homonymous blind centers.
3, the relationship between visual field defect and injury site: 5 cases (7.7%) of optic tract injury, non overlapping Homo blindness, lateral geniculate injury, 11 cases (16.9%), 6 cases (9.2%) showing non overlapping Homo blindness, 5 (7.7%) overlapped homonymous blindness, 3 cases (4.6%) with macular avoidance; occipital lobe injury. In 20 cases (30.8%), 4 cases (6.2%) were non overlapping Homo blind, 9 (13.9%) were overlapping Homo blind, 6 cases (9.2%) were cortical blindness, 1 (1.5%) was Homo blind center, of which 8 cases (12.5%) showed macular avoidance; multiple injuries accounted for 29 cases (44.6%). Partial blindness, 2 cases (3%) were cortical blindness, including 3 macular withdrawal (4.6%).
4, the relationship between visual field improvement and course of disease after medication: 65 patients were divided into 4 groups according to the duration of the disease. The results showed that the first group: the course time was less than 1 months, the visual field was improved in 19 cases (29.2%) after medication, and 2 cases (3.1%) were not improved; the second group: the course time was 1, or less than 3 months, and the field of vision after medication was improved 1. In 5 cases (23.1%), 3 cases (4.6%) were not improved; the third group: the course time was 3, less than 6 months, the field of vision was improved in 7 cases (10.8%), and 8 cases (12.3%) was not improved.
There was no significant difference in the difference between the first and the second groups (P 0.05). The difference between the second groups and the third groups was statistically significant (x 2=3.438, P 0.05), and there was no significant difference between the third and fourth groups (P 0.05). The difference was statistically significant between the improvement of the visual field within 3 months of the disease and the comparison between the 3 months of the 3 months. X 2=10.787, P 0.05).
Conclusion:
1 most of the craniocerebral trauma caused by the posterior segment of optic chiasma is more common in young men aged 31~40 years.
2 the visual lesion of the posterior optic interasiasa is more likely to cause damage to the visual field of the patient, and the patients may have different types of visual field changes, in which the non overlapping Homo blindness is more common.
3 early nutrition nerve and improved microcirculation have a positive effect on the recovery of visual field defects caused by traumatic optic posterior optic interasiasa, and the possibility of improving the visual field after 3 months of treatment is more likely.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R779.1

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