Optic nerve damage in head trauma: clinical and experimental studies.
Optic nerve damage in head trauma: clinical and experimental studies.
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头部外伤中的视神经损伤：临床和实验研究。
DOI：
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发表时间：
1982
影响因子：
2.4
通讯作者：
K. Kawai
中科院分区：
文献类型：
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作者：
H. Matsuzaki;M. Kunita;K. Kawai
对33例钝性颅脑损伤致视神经损伤患者进行了6个月~1年的随访，平均随访9个月。11例行视神经管减压术，22例行内科治疗。51%的病例记录了视神经管骨折，两组之间的发生率无显著差异。当第一次检查时视力为零时，无法获得视力改善。忽略这些病例，42.8%的手术治疗患者和58.8%的药物治疗患者视力改善，药物治疗包括联合使用泼尼松龙、甘露醇、尿激酶和维生素B12。视神经管骨折组与非视神经管骨折组的视力改善率无差异。在日本猴中，暴露视神经并给予各种损伤，包括牵引、结扎和小视神经鞘切除。牵拉结扎后，视觉诱发反应（VEP）消失或降低，但在解除损伤后，VEP有恢复的趋势。视神经结扎后，局部光刺激诱发VEP的阈值升高，但视神经结扎后阈值有降低的趋势。视神经鞘切除术后的影响轻微，4周后阈值升高恢复。人们认为视神经对间接损伤有抵抗力。从临床和实验研究中得出的结论是，由于头部钝挫伤的视神经损伤的机制是多方面的，并应加强治疗的情况下，而不是通过手术干预。
A total of 33 cases with optic nerve damage due to blunt head trauma were followed for 6 months to one year with the average follow-up period of 9 months. Eleven cases were treated by surgical decompression of the optic canal and 22 cases were followed by medical treatment. The optic canal fracture was documented in 51% of the cases, and the incidence was not significantly different between both groups. When the visual acuity was zero at the time of the first examination, no visual improvement could be obtained. Omitting these cases, visual improvement was seen in 42.8% of patients treated by surgery and in 58.8% of patients with medical treatment, which consisted of a combined use of prednisolone, mannitol, urokinase and vitamin B12. The percentage of visual improvement did not differ between cases with and without optic canal fracture. In the Japanese monkey, the optic nerve was exposed and various insults were given, including traction, ligation and small optic sheath resection. After traction and ligation, the visually evoked response (VEP) became extinguished or reduced, but after release from the insult, a tendency of recovery was found in the VEP. The threshold to elicit the VEP by localized light stimulus was increased by optic nerve ligation, but after its release the threshold tended to decrease. The effects of the optic nerve sheath resection were slight, and the increase in the threshold recovered after 4 weeks. It was thought that the optic nerve is resistant to indirect insults. From the clinical and experimental studies, it was concluded that the mechanism of the optic nerve damage due to blunt head trauma is multiple, and that the cases should be treated by intensive medical treatment rather than by surgical intervention.