摘要
目的:应用计算流体力学(computational fluid dynamics,CFD)方法,分析桡静脉吻合方式对前臂皮瓣血液流场的影响,初步探讨其临床意义。方法:应用Pro/E(Wildfire 4.0)软件,分别建立前臂皮瓣桡静脉与受区3类不同管径静脉的4种吻合方式(Ⅰ型:匹配吻合;Ⅱ型:水平残端吻合;Ⅲ型:成角吻合;Ⅳ型:端-侧吻合)的整体三维几何模型。将上述几何模型导入SC/Tetra 8.0软件,进行网格划分与计算。皮瓣设定Porous压损模型,桡动脉入口速度20mm/s,受区静脉出口压力0 Pa。通过获取各血管截面的压力、速度分布信息,研究4种静脉吻合方式皮瓣循环系统血流动力学特征,重点分析皮瓣回流静脉,尤其是吻合口处血液流场的变化规律。采用SAS 8.0软件包的随机区组设计方差分析进行统计学处理。结果:Ⅰ型皮瓣循环各截面的平均压力显著高于其他3型(F=40.99,P<0.001);Ⅱ型吻合口出现血液漩涡现象;Ⅲ型、Ⅳ型吻合口血液流线平稳,Ⅳ型桡静脉回流有"支流吸附"现象发生;皮瓣循环的压力损失在血管蒂部桡静脉内最为显著(F=97.00,P<0.001)。结论:Ⅲ、Ⅳ型是较理想的吻合方式。理论上,合理缩短血管蒂长度及选择较粗大伴行桡静脉进行吻合,可有效减少皮瓣的循环阻力。
PURPOSE：Using the computational fluid dynamics to analyse the alteration of flow field of free forearm flap with 4 different venous anastomotic techniques,and to preliminarily explore its clinical significance.METHODS：Three dimensional geometric models of radial forearm flap with 4 types of anastomotic techniques between radial vein and recipient vessels were established by Pro/E（Wildfire 4.0） as follow：type Ⅰ（matched anastomosis）,type Ⅱ（stump anastomosis）,type Ⅲ（angular anastomosis） and type Ⅳ（end-to-side anastomosis）.Then the established geometric models were transferred to the SC/Tetra 8.0 software for mesh generation and calculation.Porous model was applied to the flap to simulate capillary structure as before,inlet velocity of radial artery was set as 20mm/s and outlet pressure of recipient vein as 0 Pa.By comparing pressure and velocity distribution on different cross sections of blood vessels,hemodynamic feature of the flap with 4 types of anastomotic techniques was studied,focusing on the alternation of flow field of drainage system of the flap,especially at the anastomotic sites.The data was analysed using SAS8.0 software package for ANOVA.RESULTS：The pressure on the four sections of the flap circulatory system was significantly higher in type Ⅰ compared with type Ⅱ,Ⅲ and Ⅳ（F=40.99,P0.001）.Type Ⅱ presented with vortex in the anastomotic site,and type Ⅲ,Ⅳ with smooth flow.Type Ⅳ had an absorption effect at the anastomotic site.The pressure loss of the flap circulation was maximal in the radial vein of vascular pedicle（F=97.00,P0.001）.CONCLUSIONS：Type Ⅲ and Ⅳ are considered appropriate techniques to deal with caliber discrepancy of recipient site.Theoretically,reasonable reduction of the vascular pedicle length and choice of the concomitant radial vein with wider radius for anastomosis can effectively decrease the resistance of circulation in the flap.
出处
《上海口腔医学》
CAS
CSCD
2011年第3期246-250,共5页
Shanghai Journal of Stomatology
基金
上海交通大学医工交叉课题(YG2009MS41)~~
关键词
计算流体力学
前臂皮瓣
桡静脉
吻合方式
Computational fluid dynamics
Forearm flap
Radial vein
Anastomotic technique
