机械性眼外伤和爆炸性眼外伤的临床特征预后比较

Comparison of Clinical Features and Prognosis of Mechanical and Explosive Ocular Trauma

摘要: 目的：探讨机械性眼外伤与爆炸性眼外伤患者的眼部临床特征、诊疗方案及预后差别。方法：对2018年12月至2022年12月间收治的110例就诊于我院开放性眼外伤患者进行了回顾性、对照性分析。对机械性眼外伤的91只眼和爆炸性眼外伤的19只眼进行了比较，分析患者的人口特征、临床特点、诊疗方案及预后。结果：两组的年龄、性别、眼别等一般资料无统计学差异。与机械性眼外伤组相比，爆炸性眼外伤组初始最佳矫正视力较差(P < 0.01)，爆炸性眼外伤组损伤在III区的发生率较高(P = 0.001)，角膜损伤集中于角膜光学区(P = 0.018)。爆炸性眼外伤组中前房积血、虹膜睫状体损伤、瞳孔损伤及玻璃体积血的出现频率高于机械性眼外伤组(P < 0.01, P = 0.015, P = 0.007, P = 0.002)。爆炸性眼外伤组中视网膜损伤的出现频率较高(P = 0.005)，视网膜脱离严重程度更重(P < 0.01)，黄斑损伤、脉络膜损伤在爆炸性眼外伤组出现频率更高(P = 0.001, P = 0.002)，眼内容物脱出发生率较高(P = 0.002)。爆炸性眼外伤组眼球存活率较低，最终最佳矫正视力较差，增殖性玻璃体视网膜病变发生率较高，眼解剖结构恢复发生率较低(P = 0.005, P < 0.01, P = 0.001, P = 0.001)。结论：爆炸使眼内组织遭受更严重、广泛的损伤，损伤程度比单纯机械性眼外伤组严重，损伤部位多涉及眼后段，更易造成视网膜、脉络膜损伤，预后差。

Abstract: Objective: To explore the differences in clinical characteristics, diagnosis and treatment plans, and prognosis of patients with mechanical ocular trauma and explosive ocular trauma. Methods: A retrospective analysis was conducted on 110 patients with open eye injuries treated at our hospital between December 2018 and December 2022. A comparison was made between 91 eyes with mechanical ocular injury and 19 eyes with explosive ocular injury, analyzing patients’ demographics, clinical characteristics, treatment and prognosis. Results: There were no statistically significant differences in general data such as age, gender, and eye side between the two groups. Compared with the group of mechanical ocular injuries, the initial best-corrected visual acuity was lower in the group of explosive ocular injuries (P < 0.01), the incidence of injuries in Zone III was higher in the group of explosive ocular injuries (P = 0.001), and corneal injuries were concentrated in the corneal optical zone (P = 0.018). In the group of explosive ocular injuries, the frequency of anterior chamber hemorrhage, iris ciliary body injuries, pupil injuries, and vitreous hemorrhage was higher than in the group of mechanical ocular injuries (P < 0.01, P = 0.015, P = 0.007, P = 0.002). The frequency of retinal damage in the eye explosive injury group is higher (P = 0.005), and the severity of retinal detachment is greater (P < 0.01). Macular damage and choroidal damage occur more frequently in the eye explosive injury group (P = 0.001, P = 0.002), and the rate of eyeball contents coming out is higher (P = 0.002). The eye survival rate in the eye explosive injury group is lower, with ultimately poorer best corrected visual acuity, higher incidence of proliferative vitreoretinopathy, and lower rate of anatomical structure recovery (P = 0.005, P < 0.01, P = 0.001, P = 0.001). Conclusion: Explosives cause more severe and extensive damage to intraocular tissues compared to simple mechanical ocular injuries, with damage often involving the posterior segment of the eye, increasing the risk of retinal and choroidal damage and leading to poorer prognosis.