北京生物醫(yī)學工程

橫竇狹窄合并頸靜脈球高位對乙狀竇血管血流動力學影響的數(shù)值模擬

Numerical simulation of the effect of transverse sinus stenosis with high jugular bulb on hemodynamics of sigmoid sinus vessels

作者：薛曉飛穆振霞黃素琴符珉瑞李小帥仇曉妤高斌趙鵬飛王振常常宇

單位：北京工業(yè)大學環(huán)境與生命學部（北京 100124）首都醫(yī)科大學附屬北京友誼醫(yī)院放射科（北京 100050）浙江大學與學院附屬兒童醫(yī)院國家兒童健康臨床研究中心（杭州 310003）通訊作者：高斌。E-mail：[email protected]

關(guān)鍵詞：搏動性耳鳴；血流動力學；橫竇狹窄；頸靜脈球高位；數(shù)值模擬

分類號：R318.01

出版年·卷·期（頁碼）：2022·41·3（228--234）

摘要：

目的探討橫竇狹窄（transverse sinus stenosis, TSS）合并頸靜脈球高位（high-riding jugular bulbs, HJB）對乙狀竇（sigmoid sinus，SS）血管血流動力學的影響，即橫竇狹窄程度、頸靜脈球高度對乙狀竇血管血流動力學的影響，為橫竇狹窄合并頸靜脈球高位導(dǎo)致的搏動性耳鳴(pulsatile tinnitus, PT)治療提供理論依據(jù)。方法基于具有橫竇狹窄和頸靜脈球高位的搏動性耳鳴患者，利用三維建模軟件Freeform，建立橫竇狹窄程度0%、25%、50%和75%，球高度0、12.5px和25px的血管模型；利用流體動力學虛擬仿真分析軟件，對血管中的瞬態(tài)流動進行數(shù)值模擬，入口施加瞬態(tài)流速，出口施加恒定壓力；計算后得到血管的壓力和渦量等參數(shù)，進而分析橫竇狹窄合并頸靜脈球高位對乙狀竇血管的血流動力學影響。結(jié)果在相同的橫竇狹窄程度下，頸靜脈球高度的變化對乙狀竇壁異常區(qū)域（sigmoid sinus wall anomalies, SSWA）的時間平均壁面壓力（TAPavg）影響較大，而對SS處的時間平均體積渦量(TAVavgV)影響不明顯。在相同的頸靜脈球高度下，橫竇狹窄程度的加深，對SSWA區(qū)域的TAPavg和SS處的TAVavgV均有明顯的影響。結(jié)論當橫竇狹窄與頸靜脈球高位同時存在時，橫竇狹窄對乙狀竇血管血流動力學的影響顯著，橫竇狹窄可能是導(dǎo)致耳鳴的主要原因。頸靜脈球高位的存在會增大SSWA區(qū)域的壁面壓力，乙狀竇骨壁缺失可能是由高速血流長期沖擊而成。

Objective To explore the effect of transverse sinus stenosis （TSS）combined with high jugular bulb（HJB） on sigmoid sinus（SS） hemodynamics, that is, the degree of transverse sinus stenosis and the effect of the height of jugular bulb on sigmoid sinus hemodynamics. To provide a theoretical basis for the treatment of pulsating tinnitus caused by transverse sinus stenosis combined with high jugular bulb. Methods Based on patients with pulsating （PT）tinnitus with transverse sinus stenosis and jugular bulbous height, 3D modeling software Freeform was used to establish vascular models with transverse sinus stenosis degree of 0%, 25%, 50% and 75%, and bulbous height of 0, 0.5 cm and 1.0 cm. The transient flow in the blood vessel was numerically simulated by using the virtual simulation software of fluid dynamics. The transient flow rate was applied at the inlet and constant pressure was applied at the outlet. After calculation, parameters such as pressure and vorticity of vessels were obtained, and then the hemodynamic effect of transverse sinus stenosis combined with high jugular bulb on sigmoid sinus vessels was analyzed. Results At the same degree of transverse sinus stenosis, the change of jugular bulb height had a greater impact on TAPavg in sigmoid sinus wall anomalies（SSWA）region, but had no significant impact on TAVavgV in SS. At the same jugular bulb height, the deepening of transverse sinus stenosis had significant effects on TAPavg in the SSWA region and TAVavgV in the SS. Conclusions When transverse sinus stenosis and high jugular bulb exist together, the effect of transverse sinus stenosis on the hemodynamics of sigmoid sinus vessels is significant, and transverse sinus stenosis may be the main cause of tinnitus. The presence of high jugular bulb will increase the wall pressure in the SSWA region, and sigmoid sinus wall dehiscence may be caused by the long-term impact of high-speed blood flow.

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