床突旁動脈瘤頸內(nèi)動脈近端阻斷策略數(shù)值模擬及其臨床應(yīng)用

王明

摘? 要： 探討床突旁動脈瘤頸內(nèi)動脈近端阻斷策略的血流動力學(xué)參數(shù)的變化和特征，為手術(shù)方式的選擇提供指導(dǎo)。方法： 利用一例床突旁動脈瘤患者的DICOM影像數(shù)據(jù)，通過MIMICS、3-matic、Geomagic Studio、Spaceclaim、DesignModeler、Meshing等軟件建立頸內(nèi)動脈近端阻斷前后的動脈瘤及動脈瘤壁有限元模型，用Fluent、Transient Structural進行流固耦合計算求解。采用數(shù)值模擬與統(tǒng)計學(xué)分析頸內(nèi)動脈阻斷前后的動脈瘤血流動力學(xué)參數(shù)及動脈瘤壁的應(yīng)力應(yīng)變。計算出頸內(nèi)動脈阻斷前后模型的血流動力學(xué)參數(shù)及動脈瘤壁的應(yīng)力應(yīng)變參數(shù)，統(tǒng)計學(xué)結(jié)論顯示脈阻斷前后模型參數(shù)存在顯著性差異。用本項目所構(gòu)建的床突旁動脈瘤的有限元模型可有效分析不同模式下的動脈瘤血流特征，為臨床治療中手術(shù)方方案的設(shè)計提供指導(dǎo)。

關(guān)鍵詞： 床突旁動脈瘤;雙向流固耦合;近端阻斷策略;數(shù)值模擬

【Abstract】： Purpose： The aim of this project are to investigate the changes and characteristics of hemodynamic parameters of proximal carotid artery occlusion strategy for cavernous sinus aneurysm， and to provide guidance for the selection of surgical methods. Methods： DICOM image data of a patient with cavernous sinus aneurysm were used to establish the finite element model of aneurysm and aneurysm wall before and after proximal occlusion of the internal carotid artery by using MIMICS， 3-matic， Geomagic Studio， Spaceclaim， DesignModeler， Meshing and other software. Fluid-solid coupling calculation was performed with Fluent and Transient Structural.The hemodynamic parameters of aneurysm and the stress and strain of aneurysm wall before and after internal carotid artery occlusion were analyzed by numerical simulation and statistics. Results： The hemodynamic parameters of the model and the stress-strain parameters of aneurysm wall before and after internal carotid artery occlusion were calculated. Statistical results showed that there were significant differences in the parameters of the models. Conclusion： The finite element model of cavernous sinus aneurysm constructed in this project can be used to effectively analyze the blood flow characteristics of aneurysms in different modes， and provide guidance for the design of surgical procedures in clinical treatment.

【Key words】： Cavernous sinus aneurysm; Bidirectional fluid-solid coupling; Proximal block strategy; The numerical simulation

0? 引言

腦動脈瘤是一種嚴重的腦血管疾病，其破裂概率為1%[1]，床突旁動脈瘤占顱內(nèi)動脈瘤的3-5%，占頸內(nèi)動脈瘤的14%[2-3]。床突旁動脈瘤的形成與床突旁內(nèi)分支、血管硬化、自發(fā)性或外傷性血管夾層有關(guān)[4]。目前研究認為，壁面切應(yīng)力、壓力、血流速度等血流動力學(xué)參數(shù)與動脈瘤形成、發(fā)展、破裂有著密切的關(guān)系。顱內(nèi)常規(guī)動脈瘤的治療技術(shù)已經(jīng)非常成熟，但對于海綿竇、床突旁及基底動脈動脈瘤等復(fù)雜動脈瘤，采用直接夾閉或栓塞都非常困難。因此通過改變動脈瘤局部血流動力學(xué)狀態(tài)包括血流速度大小、沖擊方向或通過減少瘤內(nèi)的血流以促成血栓達到治療目的成為一種間接處理動脈瘤的策略。

近些年來，一些學(xué)者應(yīng)用計算流體力學(xué)對顱內(nèi)動脈瘤進行數(shù)值模擬分析，有的學(xué)者采用牛頓流體與非牛頓流體模式進行對比分析，也有的學(xué)者采用剛性壁的方法對動脈瘤進行數(shù)值分析[5-8]。動脈瘤是一種流體、固體相互耦合的物理場，而應(yīng)用雙向流固耦合進行數(shù)值模擬分析更接近于動脈瘤的血流真實流動狀況。本文建立顱內(nèi)床突旁動脈瘤頸內(nèi)動脈近端阻斷前后的雙向流固耦合模型，利用Ansys有限元軟件對動脈瘤進行求解，獲得血流動力學(xué)參數(shù)、應(yīng)力應(yīng)變情況并對結(jié)果進行配對t檢驗統(tǒng)計學(xué)分析，進而為復(fù)雜動脈瘤的治療方案選擇提供理論指導(dǎo)。

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