200例外伤致视力损害的回顾性研究

Retrospective study of traumatic injury induced visual impairment in 200 cases

摘要:

目的：通过对外伤造成视力损害的分析，探讨其损伤的原因，受伤机制，鉴定时的要点。方法：对200例达到分级标准的眼损伤案例，从年龄、性别、损伤性质、致伤原因、相应病变、视力损伤程度等因素进行回顾性分析。结果：外伤所致视力损伤案例中男女比例为2.92∶1；左右眼比例为1.50∶1；年龄分布于2~83岁，其中40~49岁最多，平均年龄41岁。致伤原因最多的是车祸，占所有致伤原因的45.0%，其次为钝器伤，车祸所致损伤主要为视神经损伤，钝器伤则主要造成眼球挫伤。视力残疾鉴定中低视力1级和2级占44.0%，而盲目3级以上占47.7%。结论：外伤是导致视力损害的主要原因，且致盲率较高，致伤机制以车祸伤引起的神经损伤最为多见。鉴定时应注意外伤后的视力损害的与外伤是否有直接关系。单纯的角膜损伤以及外伤性青光眼所造成的视力损害低视力1级为主，但有并发症时视力损伤明显加重。

Abstract:

Objective：To investigate the causes of traumatic injury induced visual impairment and to discuss the mechanism of the in－jury and the main points during the identification. Methods：The clinical data were collected from Chongqing institute of forensic medicine（2009-2012）. The clinical data of 200 cases of visual impairment were analyzed concerning the factors of age，sex，causes，pathology and severity degree of the injury. Results：The ratio of male to female was 2.92∶1； the ratio of left eyes injury to right eyes injury was 1.50∶1；the age ranged within 2-83 years old with the highest incidence in 40-49 years old group. The major cause（45.0%） of the injury was traffic accident followed by blunt force injury. The traffic accident resulted in optical nerve injury and blunt force in－jury resulted in ocular contusion. Low vision disability in grade 1 and 2 accounted for 41.2% and blind level（grade 3） accounted for 47.7% in vision identification. Conclusions：Traumatic injury is the main cause of visual impairment and the incidence of blindness is high. The main mechanism is the optic never injury caused by traffic accidents. In the identification，we should notice whether the visual impairment after injury is directly caused by the trauma. The damage of cornea and secondary glaucoma are always the causes of low vision disability in grade 1，but when the complication comes，the harm gets worse obviously.