困难气道患者三维有限元模型解剖差异的分析
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摘要
背景:近年来随着科学技术的发展,三维模型越来越多的运用到医学领域中。气道管理是麻醉手术中最重要环节之一,而在国内外较少见有关人体气道三维有限元模型的研究。目的:应用MRI检查获得的二维断层图像重建人体气道三维有限元模型,分析困难气道三维模型的解剖差异。方法:纳入手术麻醉过程中确定为正常气道和困难气道患者各20例,获取其头颈部核磁共振二维图像数据,应用Mimics10.01软件重建包括整个下颌骨、舌骨及上气道等在内的三维实体数字化模型,利用Mimics自带测量软件测量相关指标,同时对正常人体体表标志进行测量并获得相关数据,与模型所测指标行配对比较,分析困难气道患者与正常气道患者的解剖差异。结果与结论:(1)正常气道患者下颌距离的三维模型组测量值较正常人体体表测量组偏小(P <0.01);困难气道患者下颌距离的三维模型组测量值较正常人体体表测量组偏大,但差异无统计学意义(P> 0.05);正常气道、困难气道患者下颌角角度的三维模型组测量值较正常人体体表测量组偏大,但差异无统计学意义(P>0.05);(2)在平卧位及嗅花位时,正常气道组口咽角角度、矢状切最小横截面积均大于与困难气道组(P <0.05),两组冠状切最小横截面积比较差异无显著性意义(P> 0.05);(3)结果表明,运用MRI人体气道数据可建立较为真实可靠的三维有限元模型,利用三维有限元模型可有效分析困难气道患者的解剖差异,为以后临床上工作中预测困难气道提供参考。
BACKGROUND: Three-dimensional models are more and more applied in medical fields with technology development. Airway management is a key for anesthesia; however, litter is reported on the three-dimensional finite element models of normal human airways.OBJECTIVE: To reconstruct the three-dimensional finite element model of human airway based on MRI data, and to analyze the anatomical differences in difficult airway three-dimensional model.METHODS: Twenty patients with normal airways and 20 patients with difficult airways were enrolled, and then the MRI two-dimensional imaging data of head and neck were obtained. A three-dimensional solid digital model including the entire mandible, hyoid bone and upper airway was reconstructed using Mimics 10.01. Measurement software was used to measure related indicators. At the same time, normal human body surface markers were measured to obtain relevant data to compare with the measured indexes of the model, and the differences in normal and difficult airway anatomy were analyzed.RESULTS AND CONCLUION:(1) The measured value of mandibular distance in the three-dimensional model group was significantly smaller than that in the body surface measurement group in normal airway patients(P < 0.01). The measured value of mandibular distance in the three-dimensional model group was higher than that in the body surface measurement group in patients with difficult airway(P > 0.05). The measured value of mandibular angle in the three-dimensional model group was higher than that in the body surface measurement group of normal airway patients(P > 0.05).(2) In supine and sniffing positions, the oropharyngeal angle and minimal sagittal cross-sectional area in the normal airway group were significantly higher than those in the difficult airway group(P < 0.05). There was no significant difference in the minimal coronal cross-sectional area between two groups(P > 0.05).(3) These results suggest that the human airway data obtained by MRI can establish a realistic and reliable three-dimensional finite element model, and the model can accurately analyze the anatomical differences with difficult airways, which provides reference for predicting difficult airways in clinical practice.
BACKGROUND: Three-dimensional models are more and more applied in medical fields with technology development. Airway management is a key for anesthesia; however, litter is reported on the three-dimensional finite element models of normal human airways.OBJECTIVE: To reconstruct the three-dimensional finite element model of human airway based on MRI data, and to analyze the anatomical differences in difficult airway three-dimensional model.METHODS: Twenty patients with normal airways and 20 patients with difficult airways were enrolled, and then the MRI two-dimensional imaging data of head and neck were obtained. A three-dimensional solid digital model including the entire mandible, hyoid bone and upper airway was reconstructed using Mimics 10.01. Measurement software was used to measure related indicators. At the same time, normal human body surface markers were measured to obtain relevant data to compare with the measured indexes of the model, and the differences in normal and difficult airway anatomy were analyzed.RESULTS AND CONCLUION:(1) The measured value of mandibular distance in the three-dimensional model group was significantly smaller than that in the body surface measurement group in normal airway patients(P < 0.01). The measured value of mandibular distance in the three-dimensional model group was higher than that in the body surface measurement group in patients with difficult airway(P > 0.05). The measured value of mandibular angle in the three-dimensional model group was higher than that in the body surface measurement group of normal airway patients(P > 0.05).(2) In supine and sniffing positions, the oropharyngeal angle and minimal sagittal cross-sectional area in the normal airway group were significantly higher than those in the difficult airway group(P < 0.05). There was no significant difference in the minimal coronal cross-sectional area between two groups(P > 0.05).(3) These results suggest that the human airway data obtained by MRI can establish a realistic and reliable three-dimensional finite element model, and the model can accurately analyze the anatomical differences with difficult airways, which provides reference for predicting difficult airways in clinical practice.
引文
[1]Apfelbaum JL,Hagberg CA,Caplan RA,et al.Practice guidelines for management of the difficult airway:an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.Anesthesiology.2013;118(2):251-70.
[2]马武华.困难气道的评估、预测进展[A].中国中西医结合学会麻醉专业委员会(CSIA).中国中西医结合麻醉学会[CSIA]年会暨第二届全国中西医结合麻醉学术研讨会、江苏省中西医结合学会麻醉专业委员会成立大会论文汇编[C].中国中西医结合学会麻醉专业委员会(CSIA),2015:5.
[3]薛富善,刘亚洋,李慧娴.困难气道管理策略-目前的问题和将来的方向[J].临床麻醉学杂志,2018,34(1):89-91.
[4]左明章,闫春伶.困难气道管理新进展[J].北京医学,2016,38(6):499-500.
[5]Shiga T,Wajima Z,Inoue T,et al.Predicting difficult intubation in apparently normal patients:a meta-analysis of bedside screening test performance.Anesthesiology.2005;103(2):429-437.
[6]Lundstrom LH,Moller AM,Rosenstock C,et al.High body mass index is a weak predictor for difficult and failed tracheal intubation:a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database.Anesthesiology.2009;110(2):266-274.
[7]王幸双,汪小海,李文媛,等.上呼吸道矢状面解剖学特点与声门暴露程度及插管次数的关系[J].临床麻醉学杂志,2013,29(12):1174-1178.
[8]耿清胜,朱也森.上气道CT三维重建图像评估困难气道的可行性研究[J].中国口腔颌面外科杂志,2006,4(5):352-355.
[9]赵燕玲,曲爱丽,哈若水,等.健康成人上气道及周围结构的三维有限元模型的构建[J].宁夏医学杂志,2010,32(4):329-331+290.
[10]Goni-Zaballa M,Perez-Ferrer A,Charco-Mora P.Difficult airway in a pediatric patient with Klippel-Feil syndrome and an unexpected lingual tonsil.Minerva Anestesiol.2012;78:254-257.
[11]Kim SG,Yi WJ,Hwang SJ,Choi SC,et al.Development of 3Dstatistical mandible models for cephalometric measurements.Imaging Sci Dent.2012;42(3):175-182.
[12]焦子先,郑吉驷,刘欢,等.成人颅下颌解剖测量分析[J].中国口腔颌面外科,2015,13(2):151-154.
[13]Abé-Nickler MD,P?rtner S,Sieg P,et al.No correlation between dimensional measurements and three-dimensional configuration of the pharyngeal upper airway space in CTcomputed tomography.J Craniomaxillofac Surg.2017;45(3):371-376.
[14]于申,刘迎曦.人上气道生物力学模型的研究进展[J].医用生物力学,2010,25(3):157-162.
[2]马武华.困难气道的评估、预测进展[A].中国中西医结合学会麻醉专业委员会(CSIA).中国中西医结合麻醉学会[CSIA]年会暨第二届全国中西医结合麻醉学术研讨会、江苏省中西医结合学会麻醉专业委员会成立大会论文汇编[C].中国中西医结合学会麻醉专业委员会(CSIA),2015:5.
[3]薛富善,刘亚洋,李慧娴.困难气道管理策略-目前的问题和将来的方向[J].临床麻醉学杂志,2018,34(1):89-91.
[4]左明章,闫春伶.困难气道管理新进展[J].北京医学,2016,38(6):499-500.
[5]Shiga T,Wajima Z,Inoue T,et al.Predicting difficult intubation in apparently normal patients:a meta-analysis of bedside screening test performance.Anesthesiology.2005;103(2):429-437.
[6]Lundstrom LH,Moller AM,Rosenstock C,et al.High body mass index is a weak predictor for difficult and failed tracheal intubation:a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database.Anesthesiology.2009;110(2):266-274.
[7]王幸双,汪小海,李文媛,等.上呼吸道矢状面解剖学特点与声门暴露程度及插管次数的关系[J].临床麻醉学杂志,2013,29(12):1174-1178.
[8]耿清胜,朱也森.上气道CT三维重建图像评估困难气道的可行性研究[J].中国口腔颌面外科杂志,2006,4(5):352-355.
[9]赵燕玲,曲爱丽,哈若水,等.健康成人上气道及周围结构的三维有限元模型的构建[J].宁夏医学杂志,2010,32(4):329-331+290.
[10]Goni-Zaballa M,Perez-Ferrer A,Charco-Mora P.Difficult airway in a pediatric patient with Klippel-Feil syndrome and an unexpected lingual tonsil.Minerva Anestesiol.2012;78:254-257.
[11]Kim SG,Yi WJ,Hwang SJ,Choi SC,et al.Development of 3Dstatistical mandible models for cephalometric measurements.Imaging Sci Dent.2012;42(3):175-182.
[12]焦子先,郑吉驷,刘欢,等.成人颅下颌解剖测量分析[J].中国口腔颌面外科,2015,13(2):151-154.
[13]Abé-Nickler MD,P?rtner S,Sieg P,et al.No correlation between dimensional measurements and three-dimensional configuration of the pharyngeal upper airway space in CTcomputed tomography.J Craniomaxillofac Surg.2017;45(3):371-376.
[14]于申,刘迎曦.人上气道生物力学模型的研究进展[J].医用生物力学,2010,25(3):157-162.