目的:建立上颚的三维有限元模型,咽腔,单侧完全性腭裂患者的左提肌和腭提肌,模拟双皮瓣法和Furlow反向双Z法两种手术方法,观察不同手术方式后上腭软组织应力分布及咽腔区变化,并通过重建和测量巴拉蒂尼提肌,验证了模型的准确性。
方法:模拟,Geomagic,Ansys,应用Hypermesh建立咽腔三维有限元模型,上腭,单侧完全性腭裂患者的仰卧肌。参数包括长度,angle,提肌和帕拉蒂尼肌的横截面面积等。用模拟物测量,在Ansys中模拟了双皮瓣法和Furlow反向双Z法两种手术方法,并通过超网格测量咽腔面积。
结果:上颚的三维有限元模型,咽腔,并建立单侧完全性腭裂患者双侧腭提肌;将腭穹顶水平投影特征的概念应用于腭裂手术的有限元模拟,生动地模拟了两种皮瓣方法和Furlow反向双Z方法在手术过程中的位移和弹性拉伸;两种皮瓣方法和Furlow反向双Z方法中应力最高的区域都出现在硬软腭交界处;在静息状态下,作为衡量,两种皮瓣法可使咽腔面积缩小50.9%,而Furlow反向双Z法可使咽腔面积缩小65.4%;与以往的研究相比,仰卧肌的测量结果无显著差异,确认模型的准确性。
结论:有限元方法用于建立模拟外科手术的模型,这是有效和可靠的。两种方法术后应力最高的区域是硬软腭交界处,Furlow反向双Z法的应力低于双襟翼法。在静息状态下,Furlow反向双Z法咽腔的解剖条件优于双瓣法。
结论:本文采用三维有限元方法模拟临床腭裂手术中常用的双瓣法和Furlow反向双Z法,并分析了两种手术方法咽腔面积的应力分布特征和变化,以期为外科医生选择手术方式、减少并发症的发生提供理论依据。
OBJECTIVE: To establish a three-dimensional finite element model of the upper palate, pharyngeal cavity, and levator veli palatini muscle in patients with unilateral complete cleft palate, simulate two surgical procedures that the two-flap method and Furlow reverse double Z method, observe the stress distribution of the upper palate soft tissue and changes in pharyngeal cavity area after different surgical methods, and verify the accuracy of the model by reconstructing and measuring the levator veli palatini muscle.
METHODS: Mimics, Geomagic, Ansys, and Hypermesh were applied to establish three-dimensional finite element models of the pharyngeal cavity, upper palate, and levator veli palatini muscle in patients with unilateral complete cleft palate. The parameters including length, angle, and cross-sectional area of the levator veli palatini muscle etc. were measured in Mimics, and two surgical procedures that two-flap method and Furlow reverse double Z method were simulated in Ansys, and the area of pharyngeal cavity was measured by hypermesh.
RESULTS: A three-dimensional finite element model of the upper palate, pharyngeal cavity, and bilateral levator veli palatini muscle was established in patients with unilateral complete cleft palate ; The concept of horizontal projection characteristics of the palatal dome was applied to the finite element simulation of cleft palate surgery, vividly simulating the displacement and elastic stretching of the two flap method and Furlow reverse double Z method during the surgical process; The areas with the highest stress in the two-flap method and Furlow reverse double Z method both occur in the hard soft palate junction area; In resting state, as measured, the two flap method can narrow the pharyngeal cavity area by 50.9%, while the Furlow reverse double Z method can narrow the pharyngeal cavity area by 65.4%; The measurement results of the levator veli palatini muscle showed no significant difference compared to previous studies, confirming the accuracy of the model.
CONCLUSIONS: The finite element method was used to establish a model to simulate the surgical procedure, which is effective and reliable. The area with the highest postoperative stress for both methods is the hard soft palate junction area, and the stress of the Furlow reverse double Z method is lower than that of the two-flap method. The anatomical conditions of pharyngeal cavity of Furlow reverse double Z method are better than that of two-flap method in the resting state.
CONCLUSIONS: This article uses three-dimensional finite element method to simulate the commonly used two-flap method and Furlow reverse double Z method in clinical cleft palate surgery, and analyzes the stress distribution characteristics and changes in pharyngeal cavity area of the two surgical methods, in order to provide a theoretical basis for the surgeon to choose the surgical method and reduce the occurrence of complications.