基于影像重建和数值模拟技术研究轮廓化术后额隐窝及额窦解剖结构变化对鼻气流的影响

Effect of anatomical changes of frontal recess and frontal sinus on airflow after nasalisation by image reconstruction and numerical simulation

目的通过鼻窦CT三维重建和数值模拟,分析结合DrafⅢ型额窦手术的轮廓化术后,额隐窝、额窦解剖结构变化对鼻部生理气流特征的影响,探讨结构变化与主观症状、气流特征的相关性。方法回顾性选择2006—2018年于北京同仁医院鼻科接受结合DrafⅢ型额窦手术轮廓化的10例患者,术后随访≥1年且复查鼻窦CT无异常黏膜增厚,鼻内镜下黏膜Lund-Kennedy评分除瘢痕表现外均为0分。所有患者同期填写鼻塞、吸气期额窦内刺激感和头痛的视觉模拟评分表。对照模型为1例健康成年人。数值模拟计算轮廓化模型和对照模型深吸气期的气流学特征。应用SPSS 22.0软件对量化后的检测指标进行独立样本Mann-Whitney U检验和Spearman相关性检验。结果在深吸气模拟下,轮廓化模型术后额窦口气流压力为(7.21±1.39)×104 Pa(均值±标准差,下同),低于对照模型(8.99×104 Pa);额窦口及额窦内气流速度分别为(40.10±2.46)m/s、(28.19±1.73)m/s,均高于对照模型(2.70 m/s、0.73 m/s);且两模型气流模式基本类似。无论以何种症状进行分组,两组模型的额窦口开放大小和额窦体积差异均无统计学意义。主观症状的严重程度与额窦口开放大小、额窦体积无相关关系。结论结合DrafⅢ型额窦手术轮廓化后的鼻部气流模式和分布与正常生理气流基本类似。患者额隐窝和额窦解剖结构变化与术后主观症状、鼻部气流特征未见相关关系。

Objective To describe the influence of post-operative anatomical structure changes on nasal airflow characteristics by 3D reconstruction and numerical simulation in real cases after nasalisation with DrafⅢso as to explore the correlation between the changes of anatomical structure and subjective symptoms as well as airflow characteristics.Methods Ten patients underwent nasalization with DrafⅢin Department of Rhinology in Beijing Tongren Hospital from 2006 to 2018 were selected retrospectively.Postoperative follow-up of all patients was more than 1 year.All patients had no abnormalities in their paranasal sinus CT scans and Lund-Kennedy scores were 0 except scar.VAS scores including nasal obstruction,stimulation in frontal sinus,and headache were collected at the same period.The control model was a normal person.Numerical simulation was used for calculating airflow characteristics in deep inspiratory period of both models.Independent sample Mann-Whitney U test and Spearman correlation test were used by software SPSS 22.0.Results The airflow pressure in frontal sinus ostium was(7.21±1.39)×104 Pa(Mean±SD),which was lower than that in normal subjects(8.99×104 Pa)under deep inspiratory simulation.But,the velocities in frontal sinus ostium and frontal sinus were(40.10±2.46)m/s and(28.19±1.73)m/s respectively,which were higher than those in normal one(2.70 m/s,0.73 m/s).The airflow patterns of the two models were basically similar.There was no significant difference in the opening size and volume of frontal sinus between different groups after grouped by three symptoms respectively.No correlation could be found between the opening size and volume of the frontal sinus with the appearance and severity of three subjective symptoms.Conclusions The airflow pattern and distribution after nasalisation with DrafⅢare like those of normal person.There is no correlation between the changes of anatomy in frontal recess and frontal sinus and nasal airflow characteristics as well as subjective symptoms.