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目的:应用计算流体力学(computational fluid dynamics,CFD)方法,分析桡静脉吻合方式对前臂皮瓣血液流场的影响,初步探讨其临床意义。方法:应用Pro/E(Wildfire 4.0)软件,分别建立前臂皮瓣桡静脉与受区3类不同管径静脉的4种吻合方式(Ⅰ型:匹配吻合;Ⅱ型:水平残端吻合;Ⅲ型:成角吻合;Ⅳ型:端-侧吻合)的整体三维几何模型。将上述几何模型导入SC/Tetra 8.0软件,进行网格划分与计算。皮瓣设定Porous压损模型,桡动脉入口速度20mm/s,受区静脉出口压力0 Pa。通过获取各血管截面的压力、速度分布信息,研究4种静脉吻合方式皮瓣循环系统血流动力学特征,重点分析皮瓣回流静脉,尤其是吻合口处血液流场的变化规律。采用SAS 8.0软件包的随机区组设计方差分析进行统计学处理。结果:Ⅰ型皮瓣循环各截面的平均压力显著高于其他3型(F=40.99,P<0.001);Ⅱ型吻合口出现血液漩涡现象;Ⅲ型、Ⅳ型吻合口血液流线平稳,Ⅳ型桡静脉回流有“支流吸附”现象发生;皮瓣循环的压力损失在血管蒂部桡静脉内最为显著(F=97.00,P<0.001)。结论:Ⅲ、Ⅳ型是较理想的吻合方式。理论上,合理缩短血管蒂长度及选择较粗大伴行桡静脉进行吻合,可有效减少皮瓣的循环阻力。
OBJECTIVE: To study the effect of radial vein anastomosis on blood flow field of forearm flap by using computational fluid dynamics (CFD) method and to explore its clinical significance. Methods: Four types of anastomosis of the radial vein of the forearm flap and the three different diameter veins of the affected area were established by Pro / E (Wildfire 4.0) software (type Ⅰ: matched and matched; type Ⅱ: horizontal stump anastomosis; type Ⅲ : Angular fit; type Ⅳ: end-side anastomosis) of the overall three-dimensional geometric model. The above geometry model is imported into SC / Tetra 8.0 software for meshing and calculation. Flap set Porous pressure loss model, radial artery inlet velocity 20mm / s, by the regional venous outlet pressure 0 Pa. Through obtaining the pressure and velocity distribution information of each vascular cross section, the hemodynamic characteristics of the four kinds of venous anastomosis flap circulation system were studied, and the changes of blood flow field at the anastomotic flap, especially anastomotic flap, were analyzed emphatically. Randomized block design analysis of variance using SAS 8.0 software package was used for statistical analysis. Results: The average pressure of each section of type Ⅰ flap was significantly higher than that of the other three types (F = 40.99, P <0.001). The type Ⅱ anastomosis appeared blood vortex. The type Ⅲ and type Ⅳ anastomotic blood flow was smooth, There was a “tributary sorption” phenomenon in the radial venous return; the pressure loss in the flap circulation was the most significant in the radial vein of the pedicle of the vessel (F = 97.00, P <0.001). Conclusion: Ⅲ, Ⅳ type is the ideal anastomosis. Theoretically, the reasonable shortening of the length of the pedicle and the co-operation with the coarser radial vein can reduce the circulation resistance of the flap effectively.