慢性鼻-鼻窦炎患者鼻内镜手术前后鼻腔鼻窦流场特征变化

Characteristics of nasal sinus flow in patients with chronic sinusitis before and after endoscopic sinus surgery

目的从生物力学角度分析慢性鼻-鼻窦炎(chronic rhinosinusitis,CRS)发病机制,分析鼻内镜手术与鼻腔鼻窦黏膜炎症良性转归之间的关系。方法选取1例接受鼻内镜手术CRS患者,半年后随访,选取术前、术后螺旋CT数据资料,建立鼻腔鼻窦数值模型,借助于计算流体力学数值模拟的研究方法,探求手术前、后鼻腔鼻窦气流分布和流场特征值的变化,对患者进行主观评估:鼻堵视觉模拟量表评分、嗅觉视觉模拟量表评分和鼻腔鼻窦结局测量20条;客观评估:Lund-Kennedy评分、Lund-Mackay评分和糖精实验时间,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。结果鼻内镜术后,鼻腔鼻窦数值模拟可见,鼻阻力降低,中鼻道和总鼻道气流速度降低、压力变化平缓;鼻腔鼻阈区、中鼻甲头端截面近上颌窦口截面、近后筛水平截面平均速度降低,鼻腔气流对于黏膜的剪切力降低。鼻腔鼻窦容积增大,黏膜面积-容积比降低;患者主观评估改善;客观评估减轻。结论通过计算流体力学数值模拟将不可见的气流动力学规律得以呈现,了解鼻腔鼻窦流场气流分布的改变以及流场特征值的变化,可以建立鼻内镜手术疗效评估数值平台。对认识鼻内镜手术治疗CRS的病理生理机制提供新的研究手段。

OBJECTIVE To evaluate the curative effect of endoscopic sinus surgery from the viewpoint of biomechanics analysis.METHODS We select one case undergoing nasal endoscopic surgery for chronic sinusitis patients,after half year follow-up and collect preoperative and postoperative spiral CT data to build a numerical model of nasal cavity and paranasal sinuses with computer numerical simulation(CFD) research methods,to explore nasal airflow distribution and flow field characteristics of value changes before and after the operation.Patients undergo subjective assessments:nasal obstruction of VAS score,olfactory VAS score,SNOT-20,objective assessment:Lund Kennedy score,Lund Mackay score,saccharin test time and acquisition clinical efficacy data to verify the credibility of the analysis method is feasible and the results.RESULTS The nasal resistance after endoscopic sinus surgery in nasal cavity and paranasal sinuses numerical simulation decreased,middle meatus of nose and nasal air flow velocity decreased,the pressure change slightly;nasal threshold region,middle turbinate head end section in maxillary sinus ostium section,after nearly sieve horizontal cross-section average velocity decreased,nasal airflow for the mucosa of the shear stress reduced.The volume of the nasal cavity and the area of the mucosa was increased,the volume ratio was decreased,the subjective and subjective assessment of the patients was improved,and the objective assessment was lighten.CONCLUSION Aerodynamic rules are presented through the calculation of numerical simulation of fluid mechanics which is invisible before.Better understanding of changes in the nasal airflow distribution and the changes of flow field characteristics can be useful to establish nasal endoscopic surgery in numerical analysis of offshore platform,which provides a new research tool for the understanding of the pathophy siology of chronic sinusitis by endoscopic sinus surgery.