本文選題：眼外肌 + 本構關系��； 參考：《太原理工大學》2016年博士論文

【摘要】：眼外肌疾病嚴重影響著人類的正常生活,其中僅斜視的發(fā)病率就高達1%~5%。近年來,由眼外肌Pulley(眼外肌上的結締組織,具有改變眼外肌路徑的作用)異位引起的眼外肌疾病也受到了越來越多的關注。眼外肌疾病的治療可分為非手術療法和手術療法,其中手術療法占很大的比重。眼外肌手術量的準確性是眼外肌手術成功與否的關鍵。目前,眼科醫(yī)生一般參考經(jīng)驗值來確定眼外肌的手術量。用生物力學的方法建立眼球運動模型,給出確定眼外肌手術量的方案,對實現(xiàn)眼外肌疾患手術量的個性化設計具有重要的理論價值和臨床實際意義。眼球的運動主要受六條眼外肌及其他眼眶組織的支配。在眼球運動的建模中,眼外肌力學本構關系的輸入、眼外肌Pulley功能的給定及眼眶組織對眼球運動的阻力剛度的設定都是先決條件。由于人眼眶解剖的難度且受倫理道德的約束,目前還沒有文獻報道出六條眼外肌收縮的力學本構關系,Pulley對雙眼視的生物力學意義還不清楚,其他眼眶組織對眼球運動的貢獻也有待進一步確定。本文的目的是通過研究眼外肌收縮的力學本構關系、眼外肌Pulley對雙眼視的生物力學意義及眼眶組織對眼球運動的阻力,建立相應的眼球運動模型,為臨床確定眼外肌疾病的治療方案提供理論指導。本文主要完成了以下工作:(1)提出了第一眼位神經(jīng)興奮水平下人眼外肌收縮的力學本構關系�；谇叭藢嶒炈猛庵奔〉拈L度-張力關系,假設在第一眼位神經(jīng)興奮水平下其余五條眼外肌的長度-張力曲線可在外直肌長度-張力曲線的基礎上沿張力軸平移得到,分別建立了單線眼外肌和三線眼外肌的眼球運動模型;結合第一眼位的靜力平衡方程及張應力增量平方和最小的優(yōu)化方程,分別用兩種模型得到了第一眼位神經(jīng)興奮水平下六條眼外肌收縮的力學本構關系。通過與已有實驗數(shù)據(jù)對比驗證了所得本構關系的合理性;對比眼外肌單線模型和三線模型的計算結果,證明了基于單線模型推導眼外肌收縮的力學本構關系是簡單有效的。(2)首次從生物力學角度論證了pulley存在對雙眼視的生物學意義。建立了無pulley、被動pulley和主動pulley三類眼球運動模型,分別用這三類模型模擬了正常生理范圍內(nèi)的水平雙眼運動,其中對眼球運動過程中伸長的眼外肌,弱化神經(jīng)的支配作用只考慮其被動力;應用文獻中眼外肌的被動拉伸數(shù)據(jù)結合空間力系的靜平衡方程,分別得到了三類模型中眼外肌對眼球的作用力,并對眼球的受力狀態(tài)進行分析。分析結果表明無pulley模型中左眼沿文中y軸方向的受力明顯大于pulley模型中左眼沿該方向的受力;與pulley模型相比,無pulley模型雙眼沿文中x軸方向和y軸方向受力的差異都比較大,這將會導致雙眼發(fā)生不均等的變形,進而導致雙眼對視覺目標的距離發(fā)生誤判;可見pulley對雙眼視有重要的生物力學意義。(3)獲得了兔眼眶組織對眼球運動的阻力及阻力剛度。對15只體重為2.41±0.13kg的健康新西蘭大白兔全麻后,用instron5544電子萬能材料試樣機對其眼眶組織進行了在體拉伸測試;統(tǒng)計分析了含四條眼外肌及不含眼外肌的眼眶組織在眼球水平轉(zhuǎn)動和垂直轉(zhuǎn)動過程中對眼球運動的阻力;用線性回歸方法得到了8種不同眼球運動狀態(tài)下眼眶組織對眼球運動的阻力剛度。實驗結果表明無論是對于眼球的水平轉(zhuǎn)動還是垂直轉(zhuǎn)動,若將轉(zhuǎn)動過程中發(fā)揮主導作用的兩條直肌剪斷,剩余四條眼外肌對眼球運動的阻力很小;含四條次要眼外肌的眼眶組織的阻力剛度與不含眼外肌的眼眶組織的阻力剛度之間有統(tǒng)計學差異,結果表明在兔眼水平轉(zhuǎn)動和垂直轉(zhuǎn)動的建模中這兩種剛度不能通用。這一研究可為眼球運動建模中選擇眼眶組織對眼球運動的阻力剛度提供參考。(4)從生物力學角度為臨床斜視手術方案的個性化設計提供了方法。通過建模分別用眼外肌縮短術和眼外肌后退術對水平外斜視和水平內(nèi)斜視進行了矯正。分別給出了眼外肌縮短量和后退量對斜視眼位的矯正量。將模型計算值與實際手術數(shù)據(jù)的回歸值進行了對比,驗證了本文所得眼外肌手術矯正方法的有效性;也進一步驗證了本文所得眼外肌力學本構關系的合理性。所得眼外肌手術矯正量的回歸公式可為臨床眼科醫(yī)生提供相應的術前指導。該方法可對眼外肌手術的矯正量進行個性化的術前預測。
[Abstract]:Extraocular muscle disease seriously affects human normal life, of which the incidence of only strabismus is as high as 1%~5%. in recent years. The extraocular muscle disease caused by ectopic muscle Pulley (the connective tissue on the extraocular muscles and the role of changing the extraocular muscle path) has also attracted more and more attention. The treatment of extraocular muscle diseases can be divided into non operative treatment. The accuracy of the operation volume of the extraocular muscles is the key to the success of the extraocular muscle operation. At present, the ophthalmologists generally refer to the experience value to determine the operation volume of the extraocular muscles. A biomechanical method is used to establish the eyeball motion model and to give a scheme to determine the volume of the extraocular muscles and to realize the eye. The individualized design of the volume of external muscle disease has important theoretical and clinical significance. The movement of the eyeball is dominated by six extraocular muscles and other orbital tissues. In the modeling of the eye movement, the input of the mechanical constitutive relation of the extraocular muscles, the determination of the Pulley function of the extraocular muscles and the resistance stiffness of the orbital tissue to the eye movement There are no reports of the mechanical constitutive relations of six extraocular muscles, the biomechanical significance of Pulley on binocular vision is not clear, and the contribution of other orbital tissues to the movement of the eyeball remains to be further confirmed. The purpose of this article is to understand the purpose of this article. After studying the mechanical constitutive relation of the extraocular muscle contraction, the biomechanical significance of the Pulley in the eye and the resistance of the orbital tissue to the movement of the eyeball, the corresponding ocular movement model was established to provide theoretical guidance for the treatment of the extraocular muscle disease. The following work was completed: (1) the first eye nerve was proposed. Based on the length tension relationship of the external rectus muscle, the length tension curve of the other five extraocular muscles at the first eye nerve excitation level can be moved along the tension axis of the external rectus muscle on the basis of the length tension curve of the external rectus muscle, and the unilateral extraocular muscles and the single line extraocular muscles are established respectively. The model of the eyeball movement of the three line extraocular muscles; combined with the static equilibrium equation of the first eye position and the minimum equation of the tensional stress increment square and minimum, the mechanical constitutive relation of six extraocular muscles under the first eye nerve excitation level was obtained by two models. Reason; comparing the calculation results of the unilateral and three line model of the extraocular muscles, it is proved that the mechanical constitutive relation of the extraocular muscle contraction based on the single line model is simple and effective. (2) the biological significance of pulley to binocular vision is demonstrated from the biomechanical point of view for the first time. The three types of eyeball movement without pulley, passive pulley and active pulley are established. In the model, the horizontal binocular movement in normal physiological range is simulated with these three models, in which the extrophthalmos elongated in the eye movement and the innervation of the weakening nerve are only considered to be driven. The passive stretching data of the extraocular muscles in the literature combined with the static equilibrium equation of the spatial force system, the three types of models are obtained respectively. The force of the muscles to the eyeball and the stress state of the eyeball is analyzed. The results show that the force in the Y axis direction in the left eye in the non pulley model is obviously greater than that in the left eye in the pulley model. Compared with the pulley model, there is a larger difference in the force between the square direction and the Y axis in the X axis without the pulley model. It can lead to unequal deformation of the binocular, which leads to the misjudgement of the distance between the eyes and the visual target. It can be seen that pulley has an important biomechanical significance to the binocular vision. (3) the resistance and resistance stiffness of the rabbit orbital tissue to the eye movement are obtained. After the general anesthesia of 15 healthy New Zealand rabbits with a weight of 2.41 + 0.13kg, instron5544 The electronic universal material specimen machine tested its orbital tissue in body stretching test, and analyzed the resistance to eyeball movement during the horizontal and vertical rotation of the eyeball with four extraocular muscles and the non ocular muscles, and the eye movement of the orbital tissue under 8 different eye movements was obtained by linear regression. The experimental results show that no matter the horizontal or vertical rotation of the eyeball, if the two rectus muscles that play the leading role in the rotation process are cut, the remaining four extraocular muscles have little resistance to the eye movement, and the resistance stiffness of the orbital tissue containing four minor extraocular muscles and the resistance of the orbital tissue without the extraocular muscles There are statistical differences between the stiffness and the results show that these two kinds of stiffness can not be used in the modeling of horizontal and vertical rotation of the rabbit eye. This study can provide reference for the selection of orbital tissue for the resistance stiffness of eyeball motion in the modeling of eyeball motion. (4) from the biomechanical point of view, the individualized design of the approach to the surgical approach to the bed strabismus is provided. Methods. The correction of horizontal exotropia and horizontal strabismus was performed with extraocular muscle shortening and extraocular muscle regressive operation. The correction amount of the extraocular muscle shortening and retreating amount to the strabismus position were given respectively. The ratio of the calculated value to the actual surgical data was compared. The validity of the positive method further validates the reasonableness of the mechanical constitutive relationship of the extraocular muscles. The regression formula for the correction of the extraocular muscle surgery can provide the clinical ophthalmologists with corresponding preoperative guidance. This method can be used to predict the correction of the extraocular muscle surgery.
【學位授予單位】：太原理工大學
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R777.4

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