大脑中动脉瘤血流动力学数值模拟与破口处对照分析
发布时间：2019-03-12 12:45
【摘要】：实验背景：颅内动脉瘤破裂是自发性蛛网膜下腔出血（SHA）的最常见病因，其残死率约占脑血管疾病死亡的25%。大脑中动脉瘤是颅内动脉瘤最常见类型之一，多生长于动脉血管的分叉部位，破裂后容易形成血肿并挤压周围脑组织，造成患者较高的残死率，给患者造成巨大心理压力，家庭和社会沉重负担。目前国内外对动脉瘤破口处的血流动力学特点研究较少。本研究通过术中直视确定MCCAs破口位置，结合血流动力学模拟计算对比分析，指导颅内动脉瘤的临床治疗。 目的：应用计算机及相关流体力学软件对MCCAs进行血流动力学模拟，并结合动脉瘤夹闭术中显微镜下观察动脉瘤破口位置，分析动脉瘤破口处相关血流动力学参数变化，为指导动脉瘤的临床治疗提供理论依据。 资料与方法：本实验选取了2011年9月—2014年9月吉林大学中日联谊医院神经外一科行手术治疗的颅内大脑中动脉瘤患者共35例，其中男性21例，女性14例，男：女=3:2，年龄39～64周岁，平均年龄48.00±6.30岁。35例动脉瘤患者，经头颅CTA检查均确诊为MCCAs；改良Fisher分级1级：5例，2级：12例，3级：16例，4级：2例；Hunt-Hess分级Ⅰ级：4例，Ⅱ级13例，Ⅲ级15例，Ⅳ级：2例，Ⅴ级：1例。以患者的3D-CTA影像学为原始资料，应用计算机及相关流体力学软件技术，创建MCCAs的简化几何模型，，进行血流动力学模拟计算，对照术中显微镜下确定动脉瘤破口位置，分析MCCAs的破口处相关血流动力学数值。 结果：1.术中经显微镜观察并确定MCCAs破口位置，按MCCAs的破口位置分为两类。I型：MCCAs破口位置位于瘤体侧壁(24例)；II型：MCCAs破口位置位于瘤体底部(11例)。术中发现MCCAs的破口处由于破裂出血与周围脑组织相粘连，周围组织由于血液的氧化而呈现黄褐色等颜色变化。 2.根据数值计算结果MCCAs的血流动力学特点，将MCCAs可分为两组：A组：MCCAs破裂口位置位于流入道转折处（27例），其中包括破裂口位置位于瘤体底部（3例）；B组：MCCAs破裂口位置位于瘤体底部（11例）。 3.MCCAs有子瘤的患者有17例，无子瘤的患者有18例，且20例有子瘤患者中A型动脉瘤13例，B型动脉瘤7例。 4.MCCAs破裂口位置位于侧壁的动脉瘤，破裂口处剪切力与流速较大；MCCAs破裂口位于瘤体底部动脉瘤，破裂口处剪切力与流速较小。 结论：本研究基于头颅3D-CTA影像资料，利用计算机技术，创建个体化刚性壁MCCAs模型，成功地进行了血流动力学数值模拟，对所得多项血流动力学参数进行分析，为动脉瘤患者临床治疗提供了理论依据；本实验操作简便,周期性短,重复性强，价格低廉。通过对MCCAs破口处血流动力学分析，同动脉瘤夹闭术中显微镜下直接观察动脉瘤破口的位置相结合，是研究血流动力学的一个新方向
[Abstract]:Background: intracranial aneurysm rupture is the most common cause of spontaneous subarachnoid hemorrhage (SHA), and its death rate is about 25% of cerebrovascular death. Middle cerebral aneurysm is one of the most common types of intracranial aneurysms, most of which grow in the bifurcation of arterial vessels. After rupture, it is easy to form hematoma and squeeze the surrounding brain tissue, resulting in a high mortality rate of the patient and causing great psychological pressure on the patient. A heavy burden on the family and society. At present, there are few researches on the hemodynamic characteristics of ruptured aneurysm at home and abroad. The purpose of this study was to guide the clinical treatment of intracranial aneurysms by direct vision determination of MCCAs rupture location and comparative analysis of hemodynamic simulation. Objective: to simulate the hemodynamics of MCCAs with computer and related fluid dynamics software, and to observe the location of aneurysm rupture under microscope, and to analyze the changes of relevant hemodynamic parameters at the rupture of aneurysm. To provide a theoretical basis for guiding the clinical treatment of aneurysms. Materials and methods: from September 2011 to September 2014, 35 patients with intracranial middle cerebral aneurysms (21 males, 14 females, male: female = 3) were selected from the first Department of Neurosurgery, Jilin University Sino-Japanese Friendship Hospital, China-Japan Friendship Hospital, Jilin University, China-Japan Friendship Hospital, Jilin University. The mean age was 48.00 卤6.30 years old. 35 patients with aneurysm were diagnosed as MCCAs; by head CTA examination. Modified Fisher grade 1: 5 cases, grade 2: 12 cases, grade 3: 16 cases, grade 4: 2 cases, Hunt-Hess grade 鈪
本文编号：2438788
[Abstract]:Background: intracranial aneurysm rupture is the most common cause of spontaneous subarachnoid hemorrhage (SHA), and its death rate is about 25% of cerebrovascular death. Middle cerebral aneurysm is one of the most common types of intracranial aneurysms, most of which grow in the bifurcation of arterial vessels. After rupture, it is easy to form hematoma and squeeze the surrounding brain tissue, resulting in a high mortality rate of the patient and causing great psychological pressure on the patient. A heavy burden on the family and society. At present, there are few researches on the hemodynamic characteristics of ruptured aneurysm at home and abroad. The purpose of this study was to guide the clinical treatment of intracranial aneurysms by direct vision determination of MCCAs rupture location and comparative analysis of hemodynamic simulation. Objective: to simulate the hemodynamics of MCCAs with computer and related fluid dynamics software, and to observe the location of aneurysm rupture under microscope, and to analyze the changes of relevant hemodynamic parameters at the rupture of aneurysm. To provide a theoretical basis for guiding the clinical treatment of aneurysms. Materials and methods: from September 2011 to September 2014, 35 patients with intracranial middle cerebral aneurysms (21 males, 14 females, male: female = 3) were selected from the first Department of Neurosurgery, Jilin University Sino-Japanese Friendship Hospital, China-Japan Friendship Hospital, Jilin University, China-Japan Friendship Hospital, Jilin University. The mean age was 48.00 卤6.30 years old. 35 patients with aneurysm were diagnosed as MCCAs; by head CTA examination. Modified Fisher grade 1: 5 cases, grade 2: 12 cases, grade 3: 16 cases, grade 4: 2 cases, Hunt-Hess grade 鈪
本文编号：2438788
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