【作者】 刘海玉；

【导师】 王宏磊；

【作者基本信息】 吉林大学 ， 外科学， 2011， 硕士

【摘要】 目的：以三维计算机数值模拟观察大脑中动脉分叉处动脉瘤及不完全夹闭瘤颈部的动脉瘤的血流动力学特性。对象：选择2009年10月吉林大学第一医院神经外科住院患者1例。患者,女,69岁,头部CTA检查：右侧大脑中动脉分叉处动脉瘤。方法：利用临床头部3D-CTA血管造影图建立动脉瘤数值模型。使用CATIA软件对患者的动脉瘤进行三维模型的建立。将三维模型转换成IGS格式,导入到Gambit中,进行进一步修改,处理后生成动脉瘤的三维网格。定义边界条件及提取血流速度波后,应用Fluent软件进行动脉瘤数值模拟。结果：大脑中动脉分叉处动脉瘤的血流动力学表现同其他部位动脉瘤相似。其流场表现为动脉瘤的流入动脉的小部分血流流入瘤内,而大部分血流因受到瘤颈部扰流的干扰,直接流入流出动脉。血流流入动脉瘤内后,经过复杂的血流运动后由瘤颈处流出,最后进入流出动脉。动脉瘤瘤顶部的血流速度较缓慢,压力较小,切应力几乎为0。瘤颈部的血流速度较快,压力及切应力相对较大。大脑中动脉分叉处动脉瘤不完全夹闭的血流动力学分析的结果为随着动脉瘤瘤颈部夹闭程度的增高,动脉瘤瘤颈部的血流速度、切应力、压力明显增加。瘤顶部的压力也有所增加,但是相对瘤颈部较小。血流速度及切应力未见明显改变。结论：1.大脑中动脉分叉处动脉瘤瘤顶部的血流速度较缓慢,压力较小,切应力几乎为0,为动脉瘤破裂的好发部位；瘤颈部的血流速度较快,压力及切应力相对较大,为动脉瘤的生长及扩大部位。2.应对大脑中动脉分叉处动脉瘤进行完全性的夹闭,否则治疗意义不大,甚至可能有增加动脉瘤生长速度等危险。更多还原

【Abstract】 Objective:To observe the hemodynamic characteristics of aneurysm which located middle cerebral artery bifurcation area and after it incompletely clipped by three-dimension computer numerical simulation method.Participant:One inpatient from Department of Neurosurgery, The First Hospital Affiliated to Jilin University was selected at 2009.10.Patient, Female,69-year-old with right middle cerebral artery bifurcation aneurysm.Methods:Aneurysm numerical model was constructed by three-dimensional computed tomography,and reconstructed at CATIA software. The images were transform to IGS file which further introduced into Gambit software to modify and obtain the three-D meshes of aneurysms.Then the computational fluid dynamics software was used to simulate the blood flow and analyze the hydrodynamics.Result:The hemodynamic of Middle cerebral artery bifurcation aneurysm is similar to the other area aneurysm。Its flow distribution is showed to be a small part blood fluid from inlet artery flowing into aneurysm,and a large part blood fluid directly flowing into outlet arteries caused by turbulent flow of the aneurysm neck area.the blood fluid coming from inlet artery flow by complicated way in the aneurysm and finally come out of aneurysm and flow into outlet arteries.At the aneurysm dome area,the blood fluid velocity is slow,the press is low and the wall shear stress is almost 0. At the aneurysm neck area,the blood fluid velocity is fast,the press and the wall shear stress is high.With clipping the aneurysm neck area aggravation, the blood fluid velocity,the press and the wall shear stress is increased at the aneurysm neck area. at the aneurysm dome area the press is also increased, but the degree is smaller than the aneurysm neck area.the blood fluid velocity and the wall shear stress of the aneurysm dome almost don’t change.Conclution: 1.At the aneurysm dome area,the blood fluid velocity is slow,the press is low and the wall shear stress is almost 0,Therefore the the aneurysm dome area is likely to rupture. At the aneurysm neck area,the blood fluid velocity is fast,the press and the wall shear stress is high,Therefore the aneurysm neck is the area to make aneurysm growing and enlarging.2. Middle cerebral artery bifurcation aneurysm should be completely clippted, or the treatment may be not effective,even it is possible to make the aneurysm growing.更多还原