Zhu Xiaoli, Sun Kangli, Xia Xin, Chen Yu, Sun Anqiang, Chen Xingming
Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China.
Front Bioeng Biotechnol. 2023 Jan 17;11:1117483. doi: 10.3389/fbioe.2023.1117483. eCollection 2023.
The clavicular periosteum is a suitable material for trachea reconstruction. However, because the periosteum is softer and has different mechanical properties than tracheal cartilage, the mechanical loads under physiological conditions after trachea reconstruction may cause collapse or stenosis of the repaired trachea. In this study, the mechanical properties of the clavicular periosteum were tested, and the 3D trachea geometry was constructed based on CT-scanning images acquired before the surgery. Differing degrees of stenosis (0%, 33%, and 55%) for the repaired trachea sections were predetermined, presenting the different degrees of the tracheal cross-sectional area immediately after clavicular periosteum reconstruction. Then the biomechanical environments of the trachea and the airflow were simulated and analyzed. In the fluid mechanics simulation, the air pressure on the patch area decreased with increasing degrees of stenosis, while the fluid velocity increased as stenosis increased. In solid mechanics simulations, patch area deformation increased as the cross-sectional area of the trachea decreased, and the stress in the patch increased as stenosis increased. The solid stress changes may cause tissue remodeling, thickening, and scarring of the patch area. The fluid mechanical changes in the repaired trachea would further aggravate the stenosis. The numerical simulation study would provide references for biomechanical evaluation of trachea reconstruction surgery. The surgical indications may be expanded in the future based on the model prediction results.
锁骨骨膜是气管重建的合适材料。然而，由于骨膜比气管软骨更柔软且具有不同的力学性能，气管重建后生理条件下的机械负荷可能导致修复后的气管塌陷或狭窄。在本研究中，测试了锁骨骨膜的力学性能，并基于手术前获取的CT扫描图像构建了三维气管几何模型。预先设定修复后的气管段不同程度的狭窄（0%、33%和55%），呈现锁骨骨膜重建后气管横截面积的不同程度。然后对气管和气流的生物力学环境进行模拟和分析。在流体力学模拟中，贴片区域的气压随着狭窄程度的增加而降低，而流体速度随着狭窄程度的增加而增加。在固体力学模拟中，贴片区域的变形随着气管横截面积的减小而增加，贴片区域的应力随着狭窄程度的增加而增加。固体应力变化可能导致贴片区域的组织重塑、增厚和瘢痕形成。修复后气管的流体力学变化会进一步加重狭窄。数值模拟研究将为气管重建手术的生物力学评估提供参考。未来可能会根据模型预测结果扩大手术适应症。
