颈动脉粥样硬化的流体力学模型:旋转手法下颈动脉粥样硬化斑块的血流动力学变化
|
摘要
背景:颈椎旋转推拿手法是颈椎病的非手术治疗方法之一,其疗效显著,但对颈动脉粥样硬化患者的安全性仍待探讨。目的:分析颈椎旋转手法下粥样硬化颈动脉的血流动力学改变,探讨颈椎旋转手法对斑块血流动力学影响。方法:筛选颈动脉分叉处狭窄伴有斑块MRI影像资料8例。建立颈动脉粥样硬化的流体力学模型,赋予通用血流边界条件,模拟手法旋转颈椎时颈动脉拉伸情况,将模型拉伸为无拉伸的对照组、7%拉伸组、16%拉伸组,模拟斑块的血流动力学参数变化。血流动力学指标分别为斑块壁面剪切力、斑块最大壁面剪切力、斑块平均最大壁面剪切力、斑块上游剪切力、斑块下游剪切力、斑块处血流速度和血流矢量图,对拉伸组与无拉伸对照组进行对照分析。结果与结论:①7%拉伸组的血流动力学指标与对照组比较均无显著性差异(P> 0.05);16%拉伸组的血流动力学指标与对照组相比,斑块壁面剪切力、斑块最大壁面剪切力及斑块上游剪切力增大(P <0.05),其余指标无显著差异;②结果提示,旋转手法对颈动脉的不同拉伸对斑块的影响不同,大幅度16%应变的拉伸可能会影响斑块的血流动力学情况。
BACKGROUND: Cervical rotation manipulation is a non-surgical method of cervical spondylosis, showing significant treatment efficacy. But the safety for patients with carotid artery atherosclerosis remains obscure. OBJECTIVE: To analyze the hemodynamic changes of atherosclerotic carotid arteries treated by cervical rotatory manipulation, and to explore the effect of cervical rotatory manipulation on the hemodynamics of atherosclerotic plaque. METHODS: Eight cases of stenosis of ramification of the carotid artery with plaque on MRI. The hemodynamic model of carotid artery atherosclerosis was established, assigned with general boundary conditions and simulated the cervical stretch during cervical rotatory manipulation. All models were grouped and stretched into 0%(control group), 7% and 16% stretch to simulate the hemodynamic changes of atherosclerotic plaque. The hemodynamic parameters, including average wall shear stress, the maximum wall shear stress, the average maximum wall shear stress, the blood velocity of the plaque, and blood flow vectorgraph were compared among groups. RESULTS AND CONCLUSION:(1) All hemodynamic parameters had no significant differences between 7% stretch and control groups(P > 0.05). Compared with the control group, the wall shear stress, the maximum wall shear stress, and the maximum wall shear stress in the 16% stretch group were significantly increased(P < 0.05), and other indexes showed no significant differences.(2) In summary, different stretches by cervical rotatory manipulation possess different effects on plaque, and a 16% stretch may affect the hemodynamics of plaque.
BACKGROUND: Cervical rotation manipulation is a non-surgical method of cervical spondylosis, showing significant treatment efficacy. But the safety for patients with carotid artery atherosclerosis remains obscure. OBJECTIVE: To analyze the hemodynamic changes of atherosclerotic carotid arteries treated by cervical rotatory manipulation, and to explore the effect of cervical rotatory manipulation on the hemodynamics of atherosclerotic plaque. METHODS: Eight cases of stenosis of ramification of the carotid artery with plaque on MRI. The hemodynamic model of carotid artery atherosclerosis was established, assigned with general boundary conditions and simulated the cervical stretch during cervical rotatory manipulation. All models were grouped and stretched into 0%(control group), 7% and 16% stretch to simulate the hemodynamic changes of atherosclerotic plaque. The hemodynamic parameters, including average wall shear stress, the maximum wall shear stress, the average maximum wall shear stress, the blood velocity of the plaque, and blood flow vectorgraph were compared among groups. RESULTS AND CONCLUSION:(1) All hemodynamic parameters had no significant differences between 7% stretch and control groups(P > 0.05). Compared with the control group, the wall shear stress, the maximum wall shear stress, and the maximum wall shear stress in the 16% stretch group were significantly increased(P < 0.05), and other indexes showed no significant differences.(2) In summary, different stretches by cervical rotatory manipulation possess different effects on plaque, and a 16% stretch may affect the hemodynamics of plaque.
引文
[1]李义凯.脊柱推拿的基础与临床[M].北京:军事医学科学出版社,2001:1-2.
[2]Haldeman S,Carey P,Townsend M,et al.Arterial dissections following cervical manipulation:the chiropractic experience.CMAJ.2001;165(7):905-906.
[3]Caro CG.Discovery of the role of wall shear in atherosclerosis.Arterioscler Thromb Vasc Biol.2009;29(2):158-161.
[4]Cibis M,Potters WV,Gijsen FJ,et al.Wall shear stress calculations based on 3D cine phase contrast MRI and computational fluid dynamics:a comparison study in healthy carotid arteries.Nmr in Biomedicine.2014;27(7):826-834.
[5]Lee SW,Antiga L,Spence JD,et al.Geometry of the Carotid Bifurcation Predicts Its Exposure to Disturbed Flow.Stroke.2008;39(8):2341-2347.
[6]荆利娜,高培毅,林燕,等.基于磁共振成像的颈动脉粥样硬化斑块局部血流动力学平台研究[J].中国现代神经疾病杂志,2014,14(7):608-614.
[7]Gao H,Long Q,Sadat U,et al.Stress analysis of carotid atheroma in a transient ischaemic attack patient using the MRI-based fluid-structure interaction method.Br JRadiol.2009;82 Spec No 1(special_issue_1):S46.
[8]Banks J,Bressloff NW.Turbulence modeling in three-dimensional stenosed arterial bifurcations.J Biomech Eng.2007;129(1):40-50.
[9]谌祖江,李义凯.颈部推拿引起脑卒中的临床概况及其发生机制[J].颈腰痛杂志,2014,35(1):50-53.
[10]Gao H,Long Q,Graves M,et al.Carotid arterial plaque stress analysis using fluid-structure interactive simulation based on in-vivo magnetic resonance images of four patients.JBiomech.2009;42(10):1416-1423.
[11]Li ZY,Howarth SP,Tang T,et al.Structural analysis and magnetic resonance imaging predict plaque vulnerability:a study comparing symptomatic and asymptomatic individuals.J Vasc Surg.2007;45(4):768-775.
[12]张明明,贾化平,梁会泽,等.联合应用颈动脉超声及经颅多普勒超声对缺血性脑卒中的诊断价值[J].中国超声医学杂志,2015,31(3):197-200.
[13]Herzog W,Tang C,Leonard T.Internal Carotid Artery Strains During High-Speed,Low-Amplitude Spinal Manipulations of the Neck.J Manipulative Physiol Ther.2015;38(9):664-671.
[14]谌祖江.旋转手法对早期动脉粥样硬化斑块稳定性的影响[D].广州:南方医科大学,2015.
[15]刘冬梅,何文.血流剪切力与颈动脉粥样硬化的关系[J].中国卒中杂志,2008,3(10):778-782.
[16]危当恒,王贵学,唐朝君,等.剪切应力特性对血管内膜增生及动脉粥样斑块形成的影响[J].中国动脉硬化杂志,2006,15(6):410-414.
[17]邱菊辉,王贵学,雷道希.血流动力学与动脉粥样硬化斑块的稳定性及其机制[J].中国动脉硬化杂志,2009,17(6):495-497.
[18]Fry DL.Certain histological and chemical responses of the vascular interface to acutely induced mechanical stress in the aorta of the dog.Circ Res.1969;24(1):93-108.
[19]Miyazaki Y,Nomura S,Miyake T,et al.High shear stress can initiate both platelet aggregation and shedding of procoagulant containing microparticles.Blood.1996;88(9):3456.
[20]Cecchi E,Giglioli C,Valente S,et al.Role of hemodynamic shear stress in cardiovascular disease.Atherosclerosis.2011;214(2):249-256.
[21]Martin D,Zaman A,Hacker J,et al.Analysis of haemodynamic factors involved in carotid atherosclerosis using computational fluid dynamics.Br J Radiol.2009 Jan;82 Spec No 1:S33-8.
[22]刘莹,罗院明,殷艳飞,等.动脉内流-固耦合作用下两相血流动力学数值模拟[J].介入放射学杂志,2017,26(3):253-257.
[23]王淑萍,石永峰.涡流的形成及其对血液流变性的影响[J].齐齐哈尔医学院学报,2000,21(1):104-105.
[24]王汝良,胡霖霖,郭金兴,等.颈动脉分叉的非稳态数值模拟分析[J].软件,2018,39(10):36-41
[25]刘冬梅,何文,杨敏.彩色多普勒超声评价脑卒中患者颈动脉血流剪切力[J].哈尔滨医科大学学报,2014,48(1):55-57.
[26]李晓,刘晓晟.局部血流动力学与颈动脉斑块相关性的影像技术研究[J].国际医学放射学杂志,2016,39(5):535-538.
[2]Haldeman S,Carey P,Townsend M,et al.Arterial dissections following cervical manipulation:the chiropractic experience.CMAJ.2001;165(7):905-906.
[3]Caro CG.Discovery of the role of wall shear in atherosclerosis.Arterioscler Thromb Vasc Biol.2009;29(2):158-161.
[4]Cibis M,Potters WV,Gijsen FJ,et al.Wall shear stress calculations based on 3D cine phase contrast MRI and computational fluid dynamics:a comparison study in healthy carotid arteries.Nmr in Biomedicine.2014;27(7):826-834.
[5]Lee SW,Antiga L,Spence JD,et al.Geometry of the Carotid Bifurcation Predicts Its Exposure to Disturbed Flow.Stroke.2008;39(8):2341-2347.
[6]荆利娜,高培毅,林燕,等.基于磁共振成像的颈动脉粥样硬化斑块局部血流动力学平台研究[J].中国现代神经疾病杂志,2014,14(7):608-614.
[7]Gao H,Long Q,Sadat U,et al.Stress analysis of carotid atheroma in a transient ischaemic attack patient using the MRI-based fluid-structure interaction method.Br JRadiol.2009;82 Spec No 1(special_issue_1):S46.
[8]Banks J,Bressloff NW.Turbulence modeling in three-dimensional stenosed arterial bifurcations.J Biomech Eng.2007;129(1):40-50.
[9]谌祖江,李义凯.颈部推拿引起脑卒中的临床概况及其发生机制[J].颈腰痛杂志,2014,35(1):50-53.
[10]Gao H,Long Q,Graves M,et al.Carotid arterial plaque stress analysis using fluid-structure interactive simulation based on in-vivo magnetic resonance images of four patients.JBiomech.2009;42(10):1416-1423.
[11]Li ZY,Howarth SP,Tang T,et al.Structural analysis and magnetic resonance imaging predict plaque vulnerability:a study comparing symptomatic and asymptomatic individuals.J Vasc Surg.2007;45(4):768-775.
[12]张明明,贾化平,梁会泽,等.联合应用颈动脉超声及经颅多普勒超声对缺血性脑卒中的诊断价值[J].中国超声医学杂志,2015,31(3):197-200.
[13]Herzog W,Tang C,Leonard T.Internal Carotid Artery Strains During High-Speed,Low-Amplitude Spinal Manipulations of the Neck.J Manipulative Physiol Ther.2015;38(9):664-671.
[14]谌祖江.旋转手法对早期动脉粥样硬化斑块稳定性的影响[D].广州:南方医科大学,2015.
[15]刘冬梅,何文.血流剪切力与颈动脉粥样硬化的关系[J].中国卒中杂志,2008,3(10):778-782.
[16]危当恒,王贵学,唐朝君,等.剪切应力特性对血管内膜增生及动脉粥样斑块形成的影响[J].中国动脉硬化杂志,2006,15(6):410-414.
[17]邱菊辉,王贵学,雷道希.血流动力学与动脉粥样硬化斑块的稳定性及其机制[J].中国动脉硬化杂志,2009,17(6):495-497.
[18]Fry DL.Certain histological and chemical responses of the vascular interface to acutely induced mechanical stress in the aorta of the dog.Circ Res.1969;24(1):93-108.
[19]Miyazaki Y,Nomura S,Miyake T,et al.High shear stress can initiate both platelet aggregation and shedding of procoagulant containing microparticles.Blood.1996;88(9):3456.
[20]Cecchi E,Giglioli C,Valente S,et al.Role of hemodynamic shear stress in cardiovascular disease.Atherosclerosis.2011;214(2):249-256.
[21]Martin D,Zaman A,Hacker J,et al.Analysis of haemodynamic factors involved in carotid atherosclerosis using computational fluid dynamics.Br J Radiol.2009 Jan;82 Spec No 1:S33-8.
[22]刘莹,罗院明,殷艳飞,等.动脉内流-固耦合作用下两相血流动力学数值模拟[J].介入放射学杂志,2017,26(3):253-257.
[23]王淑萍,石永峰.涡流的形成及其对血液流变性的影响[J].齐齐哈尔医学院学报,2000,21(1):104-105.
[24]王汝良,胡霖霖,郭金兴,等.颈动脉分叉的非稳态数值模拟分析[J].软件,2018,39(10):36-41
[25]刘冬梅,何文,杨敏.彩色多普勒超声评价脑卒中患者颈动脉血流剪切力[J].哈尔滨医科大学学报,2014,48(1):55-57.
[26]李晓,刘晓晟.局部血流动力学与颈动脉斑块相关性的影像技术研究[J].国际医学放射学杂志,2016,39(5):535-538.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |