后交通動脈瘤的形態(tài)學(xué)因素與動脈瘤側(cè)向剪切力分布的相關(guān)性研究
發(fā)布時間：2018-04-05 15:38
本文選題：未破裂動脈瘤 切入點(diǎn)：壁面?zhèn)认蚣羟辛?/strong> 出處：《浙江大學(xué)》2017年碩士論文
【摘要】：研究背景:腦動脈瘤(Intracranial Aneurysm)是顱內(nèi)主要腦血管分支的病理性擴(kuò)張,隨著動脈成像技術(shù)的不斷普及,未破裂其檢出率逐年升高。大部分未破裂動脈瘤可以長期保持穩(wěn)定而不進(jìn)展,其中某些動脈瘤可能在短期內(nèi)迅速增大導(dǎo)致破裂,造成嚴(yán)重的后果。[1-3]動脈瘤破裂導(dǎo)致蛛網(wǎng)膜下腔出血,具有極高的致死率和致殘率,受累的人群也更為年輕,對家庭和社會造成巨大的負(fù)擔(dān)。據(jù)目前的研究數(shù)據(jù)表明,動脈瘤的這種增長模式往往是間斷的、隨機(jī)的,而不是隨著時間呈線性增長,破裂風(fēng)險難以憑經(jīng)驗簡單預(yù)測。[4-6]然而,目前處理動脈瘤的成本也較為昂貴,并且具有一定的風(fēng)險。[7]因此,在臨床工作中決定是否對一個未破裂動脈瘤進(jìn)行處理是一個難題。近年來,隨著3D影像技術(shù)的發(fā)展和計算機(jī)流體動力學(xué)(computer fluiddynamics,CFD)廣泛被應(yīng)用于腦血管血流動力學(xué)的研究,腦血管的各種形態(tài)學(xué)和血流動力學(xué)因素與動脈瘤的發(fā)生、發(fā)展與破裂的關(guān)系逐漸被揭示。就血流動力學(xué)因素而言,越來越多的研究和證據(jù)表明,壁面?zhèn)认蚣羟辛?Wall Shear Stress,WSS)在動脈瘤的病理性過程中扮演者關(guān)鍵性的因素。研究表明,動脈瘤的發(fā)生往往在那些長期受到高WSS作用的血管區(qū)域,而動脈瘤的破裂與動脈瘤壁面上低WSS的作用密切相關(guān)。在臨床工作中,神經(jīng)外科醫(yī)生接觸到的往往是血管重建或是DSA造影獲得的動脈瘤及其載瘤動脈的形態(tài)學(xué)因素。因此,本研究希望通過研究這些形態(tài)學(xué)因素與動脈瘤WSS的分布之間的相關(guān)性,從血流動力學(xué)角度分析哪些形態(tài)學(xué)因素更具危險性,為臨床上對未破裂動脈瘤的臨床決策提供一定的血流動力學(xué)依據(jù)。目的:通過研究這些形態(tài)學(xué)因素與動脈瘤WSS的分布之間的相關(guān)性,從血流動力學(xué)角度分析更具危險性的形態(tài)學(xué)因素,為臨床上對未破裂動脈瘤的臨床決策提供一定的血流動力學(xué)依據(jù)。方法:回顧性研究本院于本院行3D旋轉(zhuǎn)DSA的后交通動脈瘤病人,導(dǎo)出其血管模型,通過Mimics、Geomagic和ANSYS軟件逐步加工運(yùn)算,實(shí)現(xiàn)動脈瘤及其載瘤動脈模型的重建和血流動力學(xué)的運(yùn)算,并進(jìn)一步獲取后交通動脈瘤、頸內(nèi)動脈及后交通動脈的各形態(tài)學(xué)參數(shù),包括頸內(nèi)動脈、后交通動脈的內(nèi)徑,頸內(nèi)動脈與后交通動脈的轉(zhuǎn)角,頸內(nèi)動脈的后交通段的彎曲程度,后交通動脈瘤的頸寬、頂徑、Aspect Ratio、體積、Size Ratio、表面積、規(guī)則程度和入流角;并獲取動脈瘤壁面上的WSS的分布模式,即動脈瘤上平均WSS、受低WSS和正常及高WSS作用的區(qū)域面積。然后,通過SPSS進(jìn)行統(tǒng)計學(xué)相關(guān)性分析,尋找各形態(tài)學(xué)因素與WSS分布相關(guān)的是否存在顯著相關(guān)性。最后,本研究通過血流動力學(xué)的結(jié)果和相關(guān)文獻(xiàn),分析這些形態(tài)學(xué)因素的生理病理學(xué)效應(yīng)。結(jié)果:本研究最終共2納入了 25名于本院行3D旋轉(zhuǎn)DSA的后交通動脈瘤病人,其中男性病人8個,女性病人17個;動脈瘤為破裂的11個,未破裂的14個。動脈瘤的頂徑、Aspect Ratio 均與 Area(WSS ≤ 0.4Pa)、Area(WSS ≤ 0.4Pa)%正相關(guān),而與Area(WSS ≥ 1.5Pa)%負(fù)相關(guān);動脈瘤的大小指標(biāo)Volume、總Area均與Area(WSS≤0.4Pa)正相關(guān),而與Area(WSS≥1.5Pa)%負(fù)相關(guān);動脈瘤的頸寬和Size Ratio與Area(WSS≥1.5Pa)正相關(guān)。通過流量分析可以發(fā)現(xiàn),動脈瘤的流量與 Area(WSS ≤ 0.4Pa)、Area(WSS ≤ 0.4Pa)%正相關(guān),而與 Area(WSS ≥ 1.5Pa)%、Area(WSS ≥ 1.5Pa)%負(fù)相關(guān)。結(jié)論:本文通過研究后交通動脈瘤及其載瘤動脈形態(tài)學(xué)因素與動脈瘤上血流動力學(xué)的分布特點(diǎn),發(fā)現(xiàn)動脈瘤的大小、Aspect Ratio與動脈瘤上受低WSS作用的區(qū)域大小顯著性相關(guān),這些低WSS區(qū)域缺乏血流的直接沖擊,提示低WSS區(qū)域血液的淤滯狀態(tài)引起的生物學(xué)效應(yīng)可能是導(dǎo)致動脈瘤破裂的原因,為臨床上未破裂動脈瘤的處理提供了血流動力學(xué)的依據(jù)。
[Abstract]:Background: cerebral aneurysm (Intracranial Aneurysm) is the main pathological expansion of intracranial cerebral vascular branches, with artery imaging technology continues to spread, not broken the detection rate increased year by year. Most aneurysms can maintain long-term stability and progress, some of which may lead to rupture of the aneurysm increases rapidly in the short term, cause ruptured aneurysm of the serious consequences of the.[1-3], has a very high mortality rate and disability rate, affected individuals also have younger, causing a huge burden to the family and society. According to the data from the present study showed that the aneurysms in this growth model is often intermittent, random, but not with the time linear growth, fracture risk is difficult to empirically predict simple.[4-6] however, the treatment of the aneurysms cost is more expensive, and has a certain risk of.[7] therefore, in clinical In deciding whether to an unruptured aneurysm treatment is a difficult problem. In recent years, with the development of computer and fluid dynamics 3D imaging technology (computer Fluiddynamics CFD) is widely used in the study of cerebral vascular hemodynamics, various forms of cerebral vascular and hemodynamic factors and aneurysms and the relationship between development and rupture were gradually revealed. Hemodynamic factors, research and the increasing evidence indicates that lateral wall shear stress (Wall Shear Stress, WSS) plays a key factor in the pathological process of aneurysm. The research shows that the aneurysm occurred more often in those who have long been high the role of WSS in vascular area, and rupture and aneurysm wall aneurysms on the surface of the low WSS effect are closely related. In clinical work, the neurosurgeon is often exposed to vascular reconstruction or DSA angiography The morphological factors of aneurysms and aneurysms. Therefore, this research hope through the study of the correlation between the distribution of these morphological factors and aneurysm of the WSS, from the angle of hemodynamic analysis of morphological factors which is more dangerous, for the clinical of unruptured aneurysm clinical decision to provide hemodynamic basis. Objective: To study the correlation between the distribution of morphological factors and aneurysm WSS, morphological analysis of factors more dangerous from hemodynamics for the clinical perspective on clinical decision of unruptured aneurysms provide hemodynamic basis. Methods: a retrospective study in our hospital for 3D DSA after rotation traffic aneurysm patients, the vascular model derived by Mimics, Geomagic and ANSYS software gradually processing operations, implementation of aneurysm and its parent artery model reconstruction and blood flow The dynamics of operation, and further obtain the posterior communicating artery aneurysm, the morphological parameters of the internal carotid artery and posterior communicating artery, including internal carotid artery, posterior communicating artery diameter, angle of internal carotid artery and the traffic artery, the bending degree after traffic segment of internal carotid artery, posterior communicating artery aneurysm neck width, crown diameter. Aspect Ratio, Size Ratio, volume, surface area, regularity and inflow angle; distribution model and obtain the aneurysm wall of the aneurysm is WSS, average WSS, the area of low WSS and normal WSS and high effect. Then, statistical correlation analysis by SPSS, the morphological factors related with the distribution of WSS whether there is a significant correlation. Finally, through the study of hemodynamic results and related literature, analysis of physiology and pathology of these morphological factors effects. Results: at the end of this study, a total of 2 into 25 in the hospital 3D 鏃嬭漿DSA鐨勫悗浜ら，
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