人鼻结构与功能相关性的数值模拟与临床应用

发布时间：2018-03-04 16:02

本文选题：鼻内镜外科技术　切入点：慢性鼻窦炎　出处：《大连理工大学》2014年博士论文　论文类型：学位论文

【摘要】：上世纪70年代始,鼻内镜鼻窦手术开始用于慢性鼻窦炎的治疗。与传统Caldwell-lue鼻腔手术相比,它具有保留鼻窦基本结构,维持鼻腔鼻窦通气、引流等基本生理功能的优势。经过多年的发展,鼻内镜手术已成为微创外科治疗慢性鼻窦炎的标准方法,并延伸至中前颅底和鼻眼相关领域。“结构-功能-症状”辩证理念贯穿其中,推动了鼻内镜外科技术发展。其已逐渐从单纯治疗鼻腔鼻窦炎性感染性疾病、解剖结构异常的角度,提升到治疗上呼吸道通气等生理功能障碍的新层次,应用领域也不局限予鼻腔鼻窦病变,己进入睡眠障碍疾病的外科治疗干预中,代表性技术如鼻腔扩容技术。维持鼻腔生理功能有赖于鼻腔内气体的合理流动,从气流动力学角度深入研究鼻腔气流改变对局部以及上呼吸结构顺应性改变的影响,客观认识鼻腔内气流特征及鼻腔内结构与功能之间的相互关系,具有重要作用,鼻腔气流动力学研究在鼻内镜外科临床实践发展过程占有重要地位。运用计算流体动力学(computational fluid dynamics, CFD)方法,进行数值模拟方法,开展鼻腔与咽腔的生物力学特征研究,并检测临床主客观结果来对比,了解数值模拟方法的可行性和结果的有效性,揭示与鼻腔鼻窦疾病相关的上气道结构与功能改变之间的关系,从生物力学角度,为鼻内镜外科技术的发展搭建了数值量化分析的平台。研究内容如下： 1、选取健康成人高分辨螺旋CT影像学数据,建造60例样本的鼻腔三维模型,进行数值模拟计算,研究健康成人鼻腔气流特性,分析流场特征,数值模拟计算结果与文献报道的实验和数值模拟数据进行比较,验证本文数值模拟分析方法的可行性和计算结果的可信性,总结正常鼻腔生理状态下气流分布的规律,建立健康成人鼻腔气流流场特征值与鼻腔流场分布特征数据库,从生物力学角度揭示鼻腔结构与功能相适应性生理机制,给出鼻腔流场特征值参数,提出鼻腔功能量化的检测方法与标准,为进行鼻腔数值模拟研究奠定基础。 2、通过了解在鼻窦炎发病及鼻内镜外科手术中密切相关的窦口鼻道复合体(ostiomeatal complex,OMC)I临床意义,数值模拟来研究窦口鼻道复合体与上颌窦气流异同以及不同大小的上颌窦自然口对上颌窦流场的影响。选取1例成人女性螺旋CT影像学资料,构建鼻腔及上颌窦的三维模型,数值模拟研究上颌窦中气流和温度正常分布,了解上颌窦的生理功能；通过模拟手术研究上颌窦窦口直径的变化,上颌窦气流和温度的改变,为临床开展鼻内镜外科手术量化开放上颌窦窦口大小,提供参考意见。 3、选取一例接受鼻内镜手术慢性鼻窦炎患者临床资料,提取术前术后CT数据资料,建立鼻腔鼻窦数值模型,研究手术前后鼻腔鼻窦气流分布和流场特征值的变化,并采集临床疗效数据来验证分析方法的可行性和结果的可信性,从生物力学角度分析慢性鼻窦炎发病机制,模拟鼻腔鼻窦结构-功能-症状之间相关性,分析鼻内镜手术的矫正结构与鼻腔鼻窦黏膜炎症良性转归之间的关系,建立鼻内镜外科手术疗效评估数值平台。 4、选取3例轻、中、重度OSAHS患者行鼻腔扩容术前术后的CT资料,建立上气道数值模型,研究手术前后上呼吸道气流分布和流场特征值的变化。了解鼻腔扩容术改善鼻腔通气量的同时,对于不同严重程度的OSAHS疾病患者,整个上气道阻力的改变情况,上游鼻腔通气程度的改善能否对下游咽腔产生有益的影响,通过数值模拟评价术后OSAHS症状的改善情况,并采集临床观测数据来验证数值模拟分析方法的可行性和结果的可信性。为进一步开展鼻腔扩容手术适应症研究提供理论依据,为个性化鼻腔扩容术提供研究方法。
[Abstract]:In the beginning of 70s, endoscopic sinus surgery for treatment of chronic sinusitis. Compared with the traditional Caldwell-lue nasal surgery, it has retained the basic structure of the sinuses, nasal ventilation to maintain, drainage and other basic physiological functions. After years of development, the nasal endoscopic surgery has become the standard method for the treatment of chronic sinusitis and minimally invasive surgery. Extended to the anterior skull base and nose eye related fields. The "structure function" were dialectical philosophy through which to promote the development of endoscopic surgical technique. It has been changed from the simple treatment of nasal cavity and paranasal sinus infections, abnormal anatomy of the angle, to a new level of treatment of upper airway and other physiological function, application the field is not limited to the nasal and sinus lesions, surgical intervention has entered sleep disorders in representative techniques such as nasal cavity expansion technology. To maintain the nasal cavity Reasonable flow depends on the physiological function of the nasal cavity gas, gas flow from the perspective of dynamic change of nasal airflow and respiratory effects of local adaptation structure change, objective understanding of relationship between nasal airflow characteristics and nasal cavity structure and function, and plays an important role on nasal airflow dynamics plays an important role in the development process of the nose endoscopic surgery clinical practice. Using computational fluid dynamics (computational fluid, dynamics, CFD) method, numerical simulation method, carry out the biomechanical features of the nasal and pharyngeal cavity, and to detect the clinical results of subjective and objective to compare the effectiveness and feasibility of understanding the results of numerical simulation method, reveal the relationship between upper airway structure and function change with the nasal cavity and paranasal sinus diseases, from the view of biomechanics, built for the development of numerical quantification of nasal endoscopy Analysis platform. The contents of the research are as follows:
1 healthy adults were selected for high resolution spiral CT imaging data of 60 cases of nasal three-dimensional model construction samples, numerical simulation, healthy adult nasal airflow characteristics, analysis of flow field characteristics, comparing experimental and numerical simulation data results with the reported numerical simulation, simulation credibility analysis method and the results of feasibility to validate the numerical summary of air distribution regularity of normal nasal physiological condition, establish the flow field characteristics of healthy adult nasal airflow distribution characteristics of flow field value and the database to reveal the structure and function of nasal cavity, nasal phase adaptive physiological mechanism from the view of biomechanics, given the nasal cavity flow field characteristic parameters, the test method and standard of nasal function quantification, for numerical nasal cavity simulation study of the foundation.
2, through the understanding of the pathogenesis and sinusitis in nasal endoscopic surgery is closely related to the ostiomeatal complex (ostiomeatal complex, OMC I) clinical significance, numerical simulation to study the ostiomeatal complex and maxillary sinus flow similarities and differences and different sized natural ostium of maxillary sinus of maxillary sinus. The influence of the flow field from 1 cases of adult image female spiral CT data, construction of three-dimensional model of nasal cavity and maxillary sinus, maxillary sinus in the numerical simulation of the flow and temperature of normal distribution, understand the physiological function of the maxillary sinus; surgical simulation research by changing the diameter of the maxillary sinus, maxillary sinus airflow and temperature change, carry out clinical endoscopic surgery to quantify open maxillary sinus size, provide a reference.
3, select patients received clinical data of nasal endoscopic surgery for chronic sinusitis patients before and after surgery, extraction of CT data, the establishment of sinonasal numerical model, changes of before and after the operation of nasal airflow distribution and flow characteristic value, credibility and collection of clinical efficacy data to verify the feasibility and results analysis methods, analysis of the pathogenesis of chronic sinusitis from the view of biomechanics, the correlation between simulation structure of nasal function and symptoms, to analyze the relationship between the endoscopic surgical correction of nasal mucosa inflammation structure and benign outcome, establish the curative effect of nasal endoscopic surgery to evaluate the numerical platform.
4, a total of 3 cases of mild, severe CT, OSAHS data for patients with nasal cavity expansion before and after surgery, the upper airway establishment of numerical model, flow distribution and flow field characteristics of respiratory changes before and after the operation. The value of knowledge expansion nasal surgery to improve nasal ventilation volume at the same time, for the different severity of OSAHS disease. The upper airway resistance changes, the upper nasal ventilation improvement can have beneficial effects on the downstream of the pharyngeal cavity, through the numerical simulation to improve the situation evaluation of postoperative OSAHS symptoms, clinical observation and collection of data to verify the numerical simulation results of the credibility and feasibility analysis method. For the further development of nasal cavity expansion surgery to provide the theory of on the basis of disease research, provide research methods for personalized expansion nasal surgery.

【学位授予单位】：大连理工大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R765.9

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