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山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (8): 67-73.doi: 10.6040/j.issn.1671-7554.0.2021.0148

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30例骨性Ⅲ类畸形扁桃体肥大儿童扁桃体切除术后模拟上气道内部气流的变化

王延海,刘尹莉,刘东旭   

  • 出版日期:2021-08-10 发布日期:2021-09-16
  • 通讯作者: 刘东旭. E-mail:liudongxu@sdu.edu.cn
  • 基金资助:
    国家自然科学基金(81571010);山东大学临床研究重点项目(2020SDUCRCA005);山东大学研究生教育教学优秀成果培养计划(ZY2019004)

Simulation of upper airway hydrodynamic characteristics in 30 skeletal Class Ⅲ children with hypertrophic tonsils before and after tonsillectomy

WANG Yanhai, LIU Yinli, LIU Dongxu   

  1. Department of orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University &
    Shandong Key Laboratory of Oral Tissue Regeneration &
    Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, Jinan 250012, Shandong, China
  • Online:2021-08-10 Published:2021-09-16

摘要: 目的 通过构建骨性Ⅲ类扁桃体肥大儿童的上气道三维模型,利用计算流体动力学(CFD)评价患者扁桃体切除术后上气道内气流特性的变化,为该类患儿适宜临床疗法的选择提供理论依据。 方法 收集30例骨性Ⅲ类扁桃体肥大儿童扁桃体切除术前后的上气道计算机断层扫描数据,将扁桃体Ⅲ度肥大者纳入A组(18例)、Ⅳ度肥大者纳入B组(12例),重建其术前(T1)、术后(T2)上气道立体模型并应用CFD模拟上气道内的气体流动,评价咽部代表平面(a:后鼻孔平面;b:鼻咽最小截面;c:鼻咽与腭咽交界处;d:腭咽最小平面;e:腭咽与舌咽交界处;f:舌咽段扁桃体最大处平面;g:舌咽与喉咽交界处;h:喉咽下缘平面)的面平均压力与面平均速度、f平面的最大速度(Vmax)与最小压力(Pmin)、咽部最大气流速度(Pharynx-Vmax)、上气道最大气流速度(UA-Vmax)、咽部气流阻力(Rpharynx)、后鼻孔到f平面的压降(dP)及dP与流量比值(PQR)的变化。 结果 B组受试者代表平面的面平均压力、面平均速度在T2期降低,a、b、c、d、e、f、g平面的面平均压力与d、e、f、g、h平面的面平均速度差异有统计学意义(P<0.05)。A组截面参数在T2期也呈下降趋势,b截面的面平均压力差异有统计学意义(P<0.05)。对于VmaxPmin、Pharynx-Vmax、UA-Vmax、Rpharynx、dP与PQR,B组受试者手术前后的差异有统计学意义(P<0.05),A组手术前后的差异无统计学意义(P>0.05)。除了a、b、c平面的面平均速度与h平面的面平均压力,A、B两组的其他所有测量指标差异在T1期有统计学意义(P<0.05),所有测量指标差异在T2期无统计学意义(P>0.05)。 结论 从流体力学角度看,扁桃体切除术可有效改善骨性Ⅲ类扁桃体Ⅳ度肥大儿童上气道内部的流体特性,而对于骨性Ⅲ类扁桃体Ⅲ度肥大儿童上气道内部的气流影响不大。

关键词: 骨性Ⅲ类儿童, 扁桃体肥大, 扁桃体切除术, 上气道, 计算流体动力学

Abstract: Objective To construct the real three-dimensional models of skeletal Class Ⅲ children with hypertrophic tonsils to evaluate the hydrodynamic characteristics of their upper airways before and after tonsillectomy using computational fluid dynamics(CFD), and to provide theoretical basis when doctors develop treatment protocols for them. Methods Computed tomography images of 30 skeletal Class Ⅲ children with hypertrophic tonsils were collected and these patients were divided into groups A(tonsil grade=Ⅲ, n=18)and B(tonsil grade =Ⅳ, n=12). Three-dimensional models of their upper airways preoperative(T1)and postoperative(T2)were reconstructed. Simulations were then conducted using CFD. Measurements included area average pressure and area average velocity of representative planes(a: the plane of choana; b: minimum section of nasopharynx; c: the junction of nasopharynx and velopharynx; d: minimum section of velopharynx; e: the junction of velopharynx and glossopharynx; f: the plane of glossopharynx where tonsils were the biggest; g: the junction of glossopharynx and hypopharynx; h: the lowest plane of hypopharynx), maximal velocity(Vmax)and minimal pressure(Pmin)in plane f, maximal velocity of pharynx(Pharynx-Vmax), maximal velocity in upper airway(UA-Vmax), airflow resistance in pharynx(Rpharynx), pressure drop from choana to plane f(dP)and dP to flow ratio(PQR). Results The area average pressure and area average velocity in planes of subjects in group B decreased in T2 period. The differences of area average pressure in plane a, b, c, d, e, f, g and area average velocity in plane d, e, f, g, h were statistically significant(P<0.05). The cross-sectional parameters in group A also showed a downward trend in T2. The difference of area average pressure in plane b was statistically significant(P<0.05). For Vmax, Pmin, Pharynx-Vmax, UA-Vmax, Rpharynx, dP and PQR, the differences of subjects in group B were statistically significant(P<0.05)from T1 to T2, while those in group A were not significant(P>0.05). Besides area average velocity in planes a, b, c and area average pressure in plane h, the differences of the other measurements in groups A and B were statistically significant(P<0.05)at T1, but not significant(P>0.05)at T2. Conclusion From the point of CFD, tonsillectomy can change hydrodynamic characteristics significantly in skeletal Class III children with grade IV tonsil hypertrophy, while the same therapy can not influence those with grade III hypertrophy.

Key words: Skeletal Class Ⅲ children, Tonsil hypertrophy, Tonsillectomy, Upper airway, Computational fluid dynamics

中图分类号: 

  • R783.5
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