【摘要】：實(shí)驗(yàn)背景：顱內(nèi)動(dòng)脈瘤破裂是自發(fā)性蛛網(wǎng)膜下腔出血（SHA）的最常見(jiàn)病因，其殘死率約占腦血管疾病死亡的25%。大腦中動(dòng)脈瘤是顱內(nèi)動(dòng)脈瘤最常見(jiàn)類型之一，多生長(zhǎng)于動(dòng)脈血管的分叉部位，破裂后容易形成血腫并擠壓周圍腦組織，造成患者較高的殘死率，給患者造成巨大心理壓力，家庭和社會(huì)沉重負(fù)擔(dān)。目前國(guó)內(nèi)外對(duì)動(dòng)脈瘤破口處的血流動(dòng)力學(xué)特點(diǎn)研究較少。本研究通過(guò)術(shù)中直視確定MCCAs破口位置，結(jié)合血流動(dòng)力學(xué)模擬計(jì)算對(duì)比分析，指導(dǎo)顱內(nèi)動(dòng)脈瘤的臨床治療。 目的：應(yīng)用計(jì)算機(jī)及相關(guān)流體力學(xué)軟件對(duì)MCCAs進(jìn)行血流動(dòng)力學(xué)模擬，并結(jié)合動(dòng)脈瘤夾閉術(shù)中顯微鏡下觀察動(dòng)脈瘤破口位置，分析動(dòng)脈瘤破口處相關(guān)血流動(dòng)力學(xué)參數(shù)變化，為指導(dǎo)動(dòng)脈瘤的臨床治療提供理論依據(jù)。 資料與方法：本實(shí)驗(yàn)選取了2011年9月—2014年9月吉林大學(xué)中日聯(lián)誼醫(yī)院神經(jīng)外一科行手術(shù)治療的顱內(nèi)大腦中動(dòng)脈瘤患者共35例，其中男性21例，女性14例，男：女=3:2，年齡39～64周歲，平均年齡48.00±6.30歲。35例動(dòng)脈瘤患者，經(jīng)頭顱CTA檢查均確診為MCCAs；改良Fisher分級(jí)1級(jí)：5例，2級(jí)：12例，3級(jí)：16例，4級(jí)：2例；Hunt-Hess分級(jí)Ⅰ級(jí)：4例，Ⅱ級(jí)13例，Ⅲ級(jí)15例，Ⅳ級(jí)：2例，Ⅴ級(jí)：1例。以患者的3D-CTA影像學(xué)為原始資料，應(yīng)用計(jì)算機(jī)及相關(guān)流體力學(xué)軟件技術(shù)，創(chuàng)建MCCAs的簡(jiǎn)化幾何模型，，進(jìn)行血流動(dòng)力學(xué)模擬計(jì)算，對(duì)照術(shù)中顯微鏡下確定動(dòng)脈瘤破口位置，分析MCCAs的破口處相關(guān)血流動(dòng)力學(xué)數(shù)值。 結(jié)果：1.術(shù)中經(jīng)顯微鏡觀察并確定MCCAs破口位置，按MCCAs的破口位置分為兩類。I型：MCCAs破口位置位于瘤體側(cè)壁(24例)；II型：MCCAs破口位置位于瘤體底部(11例)。術(shù)中發(fā)現(xiàn)MCCAs的破口處由于破裂出血與周圍腦組織相粘連，周圍組織由于血液的氧化而呈現(xiàn)黃褐色等顏色變化。 2.根據(jù)數(shù)值計(jì)算結(jié)果MCCAs的血流動(dòng)力學(xué)特點(diǎn)，將MCCAs可分為兩組：A組：MCCAs破裂口位置位于流入道轉(zhuǎn)折處（27例），其中包括破裂口位置位于瘤體底部（3例）；B組：MCCAs破裂口位置位于瘤體底部（11例）。 3.MCCAs有子瘤的患者有17例，無(wú)子瘤的患者有18例，且20例有子瘤患者中A型動(dòng)脈瘤13例，B型動(dòng)脈瘤7例。 4.MCCAs破裂口位置位于側(cè)壁的動(dòng)脈瘤，破裂口處剪切力與流速較大；MCCAs破裂口位于瘤體底部動(dòng)脈瘤，破裂口處剪切力與流速較小。 結(jié)論：本研究基于頭顱3D-CTA影像資料，利用計(jì)算機(jī)技術(shù)，創(chuàng)建個(gè)體化剛性壁MCCAs模型，成功地進(jìn)行了血流動(dòng)力學(xué)數(shù)值模擬，對(duì)所得多項(xiàng)血流動(dòng)力學(xué)參數(shù)進(jìn)行分析，為動(dòng)脈瘤患者臨床治療提供了理論依據(jù)；本實(shí)驗(yàn)操作簡(jiǎn)便,周期性短,重復(fù)性強(qiáng)，價(jià)格低廉。通過(guò)對(duì)MCCAs破口處血流動(dòng)力學(xué)分析，同動(dòng)脈瘤夾閉術(shù)中顯微鏡下直接觀察動(dòng)脈瘤破口的位置相結(jié)合，是研究血流動(dòng)力學(xué)的一個(gè)新方向
[Abstract]:Background: intracranial aneurysm rupture is the most common cause of spontaneous subarachnoid hemorrhage (SHA), and its death rate is about 25% of cerebrovascular death. Middle cerebral aneurysm is one of the most common types of intracranial aneurysms, most of which grow in the bifurcation of arterial vessels. After rupture, it is easy to form hematoma and squeeze the surrounding brain tissue, resulting in a high mortality rate of the patient and causing great psychological pressure on the patient. A heavy burden on the family and society. At present, there are few researches on the hemodynamic characteristics of ruptured aneurysm at home and abroad. The purpose of this study was to guide the clinical treatment of intracranial aneurysms by direct vision determination of MCCAs rupture location and comparative analysis of hemodynamic simulation. Objective: to simulate the hemodynamics of MCCAs with computer and related fluid dynamics software, and to observe the location of aneurysm rupture under microscope, and to analyze the changes of relevant hemodynamic parameters at the rupture of aneurysm. To provide a theoretical basis for guiding the clinical treatment of aneurysms. Materials and methods: from September 2011 to September 2014, 35 patients with intracranial middle cerebral aneurysms (21 males, 14 females, male: female = 3) were selected from the first Department of Neurosurgery, Jilin University Sino-Japanese Friendship Hospital, China-Japan Friendship Hospital, Jilin University, China-Japan Friendship Hospital, Jilin University. The mean age was 48.00 鹵6.30 years old. 35 patients with aneurysm were diagnosed as MCCAs; by head CTA examination. Modified Fisher grade 1: 5 cases, grade 2: 12 cases, grade 3: 16 cases, grade 4: 2 cases, Hunt-Hess grade 鈪

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