鼻中隔矫正术或联合下鼻甲骨折外移术对鼻腔模拟气流场及气道结构影响的分析

Effect of septoplasty or in combination with outfracture of the inferior turbinate on the airflow field and nasal airway

目的探讨鼻中隔矫正术或联合下鼻甲骨折外移术对鼻腔气流场及气道结构的影响。方法对2006--2009年诊治的6例“C”型鼻中隔偏曲患者行鼻中隔矫正术或联合下鼻甲骨折外移术，术前及术后分别行鼻CT检查，根据CT分别对手术前后鼻腔气道结构进行表面三维重建，设定边界条件并求解Navier—Stokes方程。对比分析手术前后通气量为12L／min时气流场、气道结构变化。采用SPSS12．0软件进行非参数秩和检验。结果术前气道总面积、总鼻道中、下部面积宽敞侧分别为（1．61±0．18）、（0．40±0．10）、（0．40±0．14）cm。，狭窄侧分别为（1．30±0．18）、（0．33±0．05）、（0．36±0．10）cm。，双侧对比差异无统计学意义（Z值分别为1．782、1．363、0．526，P值均〉0．05）；气道总流量、总鼻道中、下部流量、下鼻甲厚度宽敞侧分别为（361±68）、（131±25）、（100±28）ml，（0．93±0．10）cm，狭窄侧分别为（178±33）、（59±26）、（59±18）ml，（0．58±0．12）cm，双侧对比差异均有统计学意义（z值分别为2．207、2．201、2．201、2．214，P值均〈0．05）；双侧气流形式均紊乱。术后气道总面积宽敞侧、狭窄侧分别为（2．55±0．44）、（2．20±0．72）cm2，术后狭窄侧总鼻道中、下部面积分别为（0．58±0．13）、（0．81±0．26）cm2，术后宽敞侧下鼻甲厚度为（0．73±0．08）cm，与术前对比差异均有统计学意义（z值分别为2．201、2．201、2．201、2．201、2．264，P值均〈0．05）；双侧气流形式稳定。术后气道阻力[（0．16±0．01）kPa·L^-1·s^-1]较术前[（0．41±0．03）kPa·L^-1·s^-1]明显减小，差异有统计学意义（Z=-2．207，P=0．027）。结论鼻中隔偏曲患者术前鼻腔气道呈失代偿性改变，通气功能减退；行鼻中隔矫正术或联合下鼻甲骨折外移术后通气功能好转，但气道结构仍有继发性、自适应性改变。

Objective To explore the effect of septoplasty or in combination with outfracture of the inferior turbinate in patients with nasal septum deviation on the airflow field and the nasal airway structure. Methods Six patients with nasal septum deviation underwent spiral CT imaging scans before surgery and during the follow-up. The 3D finite element meshes of the nasal airway were developed from the above CT scans. Given three preconditions, the nasal airflow fields were described by the Navier-Stokes and continuity equations at the inspiratory flow rate of 12 L/ min. The whole airflow patterns were obtained and then compared with the airflow flied and airway structure changes before and after surgery. SPSS 12. 0 software was used to analyze the data. Results Before surgery, area of the common airway and the middle and ventral medial regions in the concave side were （1.61 ±0. 18）, （0.40 ±0. 10）, （0.40 ±0. 14） cm2 respectively, and those of convex side were （ 1.30 ± 0. 18 ）, （ 0. 33± 0. 05 ）, （ 0. 36 ± 0. 10 ） cm2 respectively. The differences between both sides were of no statistical significance （Z value was 1. 782, 1.363, 0.526 respectively,all P 〉0.05）. Airflow of the above airways were （361 ±68）, （131 ±25）,（100 ±28） ml respectively in concave side and （178 ± 33 ）, （59± 26）, （59 ±18 ） ml respectively in convex side, which differences were significant statistically （Z value were 2. 207, 2. 201, 2. 201 respectively, all P 〈 0. 05 ）. The inferior turbinate in concave side [ （0. 93 ± 0. 10）cm] was statistically （Z =2. 214, P 〈0. 05） bigger than that in convex side[ （0. 58 ± 0. 12）cm] before surgery. The airflow fields were in disorder in both ill-airways. After surgery, area of the common airway was （2. 55 ± 0. 44） cm2 in concave side and （ 2. 20± 0. 72 ） cm2 in convex side respectively, and area of the middle and ventral medial regions in the convex side were （0. 58 ± 0. 13 ） , （0. 81 ± 0. 26 ）cm2 respectively, which differences were of significance statistically when comparing to areas before surgery （Z value were 2. 201, 2. 201, 2. 201, 2. 201, P 〈 0. 05 ）. The airflow passed through nasal airway orderly in both sides. But the thickness of inferior turbinate was （ 0. 73 ± 0. 08 ） cm in concave side after surgery, which difference was significant statistically in comparison to that before surgery （ Z = 2. 264, P 〈 0. 05 ）. Consequently, nasal resistance decreased from （0.41 ± 0. 03 ） kPa · L ^-1 . s ^- 1 to （0. 16 ± 0. 01 ） kPa · L ^-1· s ^-1 after surgery, the difience was signifieantly（Z = -2. 207 ,P = 0. 027）. Conclusion Septoplasty or in combination with outfracture of the inferior turbinate, followed by the self-adaptation consecutively, could improve the airway and breathing capacity of the nose.