计算流体动力学评估下鼻甲缩小技术改善鼻腔气流效果的有效性。
Computational Fluid Dynamics to Evaluate the Effectiveness of Inferior Turbinate Reduction Techniques to Improve Nasal Airflow.
机构信息
Department of Otolaryngology-Head & Neck Surgery, Virginia Commonwealth University, Richmond.
Syracuse Otolaryngology, PLLC, Syracuse, New York.
出版信息
JAMA Facial Plast Surg. 2018 Jul 1;20(4):263-270. doi: 10.1001/jamafacial.2017.2296.
IMPORTANCE
Inferior turbinate reduction (ITR) is a commonly performed procedure for the treatment of nasal obstruction. Which portion of the inferior turbinates should be surgically addressed to improve nasal airflow has yet to be determined.
OBJECTIVE
To use computational fluid dynamics (CFD) analysis to evaluate the airflow changes after reduction along different portions of the inferior turbinate.
DESIGN, SETTING, AND PARTICIPANTS: Computed tomographic scans of 5 patients were selected. Seven CFD models were created for each patient: 1 unaltered and 6 various ITRs, including 3 one-third ITRs (anterior, middle, and posterior one-third); 2 two-thirds ITRs (anterior and posterior two-thirds); and 1 full-length ITR model. Total airflow rate and nasal resistance was obtained through CFD analysis, and regression analysis was performed on the increased nasal volume, locations, and nasal resistance for all 5 patients.
MAIN OUTCOMES AND MEASURES
Total airflow rate and nasal resistance was obtained through CFD analysis, and regression analysis was performed on the increased nasal volume, locations, and nasal resistance for all 5 patients.
RESULTS
Full ITR over the whole length was consistently most effective to improve nasal airflow and resistance for all 5 patients (2 men and 3 women), adjusted for the volume. Regression analysis showed a strong linear (R2≥0.79) relationship between nasal volume changes and nasal airflow. However, the most effective location of partial turbinate reduction was not consistent among patients. Surprisingly, for some patients, posterior ITRs were more effective than anterior ITRs. The site of most effective partial ITR differed from 1 side to the other even in the same individual.
CONCLUSIONS AND RELEVANCE
The effectiveness of partial ITR and target location likely depends on individual patient anatomy. The fact that full ITRs were consistently most effective and the linear regression between flow and nasal volume changes may indicate that the entire length of the IT has a functional impact on nasal airflow and resistance.
LEVEL OF EVIDENCE
NA.
重要性
下鼻甲缩小术（ITR）是治疗鼻塞的常用方法。为了改善鼻气流，应该对下鼻甲的哪个部分进行手术治疗仍有待确定。
目的
使用计算流体动力学（CFD）分析来评估下鼻甲不同部位缩小后气流的变化。
设计、设置和参与者：选择了 5 名患者的计算机断层扫描。为每位患者创建了 7 个 CFD 模型：1 个未改变的和 6 个不同的 ITR，包括 3 个三分之一 ITR（前、中、后三分之一）；2 个三分之二 ITR（前、后三分之二）；和 1 个全长 ITR 模型。通过 CFD 分析获得总气流率和鼻阻力，并对所有 5 名患者的增加的鼻体积、位置和鼻阻力进行回归分析。
主要结果和措施
通过 CFD 分析获得总气流率和鼻阻力，并对所有 5 名患者的增加的鼻体积、位置和鼻阻力进行回归分析。
结果
全长 ITR 对于所有 5 名患者（2 名男性和 3 名女性），调整体积后，始终是改善鼻气流和阻力最有效的方法。回归分析显示，鼻体积变化与鼻气流之间存在很强的线性关系（R2≥0.79）。然而，部分鼻甲缩小的最有效位置在患者之间并不一致。令人惊讶的是，对于一些患者，后 ITR 比前 ITR 更有效。即使在同一患者中，有效的部分 ITR 部位也从一侧到另一侧不同。
结论和相关性
部分 ITR 的有效性和目标位置可能取决于个体患者的解剖结构。事实上，全长 ITR 始终是最有效的，并且流量和鼻体积变化之间的线性回归可能表明 IT 的整个长度对上鼻气流和阻力有功能影响。
证据水平
无。
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