眼创伤评分法在军人机械性眼外伤中的临床应用

摘要

Objective To evaluate the predictive value of ocular trauma score (OTS) in mechanical ocular injuries occurring in military forcesi and compare the difference of OTS application between ocular injury caused by military training and non-military training. Methods The data of 633 inpatients from armed forces suffering from injury of 665 eyes were retrospectively reviewed. Of the 665 injured eyes, 326 were injured during military training and 339 during non-military training. The likelihood of final visual acuity (VA) calculated with the OTS score was compared with that by the present OTS study, and the correlation between the score and final VA was then analyzed. Results Compared with the distribution of final VA in standard OTS score, the ratio in category 1 was statistically different in present study (P<0.01), among which the ratio of no-light-perception (NLP) group was drastically lower (46% vs 73%, P<0.01), and no differences were found in other categories (P>0.05). There were significant differences in ratio of category 3 between eyes injured by military and non-military training (P<0.05), and both ratios in category 1 were significantly different compared with those in standard OTS(P＜0.01), eg. The ratio of NLP was lower (50% vs73%, P<0.01; 43% vs73%, P<0.01); and the ratio in category 2 was significantly different between the eyes injured by non-military training and standard OTS (P<0. 05). However, the OTS showed positive correlation with final VA in present study (P<0. 0001). Conclusion OTS calculated at initial examination may primarily provide a piece of prognostic information of mechanical ocular injuries, and is of special benefit for deciding a prompt management or for evacuation decision for severe ocular injuries caused by military training.%目的 探讨眼创伤评分(OTS)在军人机械性眼外伤视力预后评估中的临床应用,并分析比较军事训练和非军事训练所致眼外伤预后评分的构成差别.方法 对633例(665眼,其中军事训练伤326眼,非军事训练伤339眼)军人机械性眼外伤进行OTS评分,比较本研究纳入病例的终视力比率与OTS表推算各级终视力概率的差别,分析评分与终视力的相关性.结果 与OTS标准终视力概率表比较,本研究军人机械性眼外伤评分后终视力概率分布在OTS-Ⅰ级有显著差异(P＜0.01),特别是无光感组比值相对较低(46% vs73%,P＜0.01),其余分布无显著差异(P＞0.05).军事训练和非军事训练所致军人眼外伤之间OTS-3级视力分布存在显著差异(P＜0.05)；两者均与标准概率在OTS-1级分布有显著差异(P＜0.01),无光感组比率较低(50% vs73%,P＜0.01; 43%vs73%,P＜0.01)；非军事训练眼外伤OTS-2级与标准概率分布不同(P＜0.05).但是,无论军人机械性眼外伤总体、军事训练所致眼外伤还是非军事训练眼外伤终视力分布均与OTS评分等级存在正线性相关趋势(P＜0.0001).结论 OTS可初步为军人机械性眼外伤提供一个较为可靠的预后信息,尤其对于军事训练所致严重眼外伤的早期确立诊治及转送方案有积极意义.