背景:矫正弯曲的鼻子,尤其是筛骨的垂直板,有可能造成颅底损伤.目前,通过生物力学尚未明确确定垂直钢板切除的安全有效方法。
方法:48例鼻中隔歪斜患者的CT扫描资料分为C型,角畸形型,和S型的基于形态学的三维模型。建立了不同类型的鼻骨隔和颅底的有限元模型。截骨深度,angle,通过组装模型的不同工作条件来模拟PPE切除的力模式。观察到前颅窝的vonMises应力。
结果:当截骨线长度为0.5cm时,这个角度与法兰克福飞机成30°,并施加了50N·mm的扭矩,在这四种模型中,vonMises的颅底应力很小,显示0.049MPa(C型),0.082MPa(S型),0.128MPa(角变形型),和0.021MPa(控制模型)。当截骨线为1.5cm时,在颅底发现了最大的vonMises应力值,角度是50°,沿X轴方向的力为10N,显示0.349MPa(C型),0.698MPa(S型),0.451MPa(角变形型),和0.149MPa(控制模型)。
结论:使用较小的切除角与法兰克福平面,保守切除深度,扭转力能更好地降低颅底应力值,降低颅底骨折的风险。垂直钢板切除筛骨是矫正歪鼻的一种安全有效的技术。
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BACKGROUND: Correction of the crooked nose, especially the perpendicular plate of the ethmoid bone, has the potential to cause skull base injury. At present, the safe and effective method for perpendicular plate resection has not been clearly defined through biomechanics.
METHODS: CT scan data of 48 patients with crooked nose and deviated nasal septum were divided into C-type, angular deformity-type, and S-type based on the morphology of the 3D model. Different types of finite element models of the nasal bony septum and skull base were established. The osteotomy depth, angle, and force mode of the PPE resection were simulated by assembling different working conditions for the models. The von Mises stress of the anterior cranial fossa was observed.
RESULTS: When the osteotomy line length was 0.5 cm, the angle was at 30° to the Frankfurt plane, and 50 N·mm torque was applied, the von Mises stress of the skull base was minimal in the four models, showing 0.049 MPa (C-type), 0.082 MPa (S-type), 0.128 MPa (angular deformity-type), and 0.021 MPa (control model). The maximum von Mises stress values were found at the skull base when the osteotomy line was 1.5 cm, the angle was 50°, and the force was 10 N along the X-axis, showing 0.349 MPa (C-type), 0.698 MPa (S-type), 0.451 MPa (angular deformity-type), and 0.149 MPa (control model).
CONCLUSIONS: The use of smaller resection angle with the Frankfurt plane, conservative resection depth, and torsion force can better reduce the stress value at the skull base and reduce the risk of basicranial fracture. It is a safe and effective technique for perpendicular plate resection of the ethmoid bone in the correction of crooked nose.
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