颈内动脉虹吸部影像解剖和血流动力学模拟

目录中文摘要 (02)英文摘要 (04)正文颈内动脉虹吸部影像解剖及血流动力学模 (07)第一部分颈内动脉虹吸部影像解剖 (07)材料与方法 (07)结果 (09)讨论 (11)参考文献 (13)第二部分颈内动脉虹吸部血流动力学模拟 (15)材料与方法 (15)结果 (19)讨论 (26)参考文献 (35)致谢 (38)综述 (39)颈内动脉虹吸部影像解剖及血流动力学模拟中文摘要目的（1）颈内动脉分段及虹吸部正常解剖形态与测量。

（2）颈内动脉虹吸部钙化分布，正常组与钙化组比较。

（3）模拟正常颈内动脉虹吸部血流动力学特点、动脉硬化狭窄后血流动力学改变，二者比较探讨血流动力学因素与虹吸部硬化的关系。

方法（1）选择研究对象的条件：本院2011年1月-2011年12月行头颈CTA检查患者中，查找50岁以上住院病例作为研究对象，包括正常组70例、钙化组70例。

在图像工作站上重建虹吸部血管，观察血管的形态，并测量C4、C5段折角及血管直径，对比两组的差异。

（2）基于CTA数据实现颈内动脉有限元建模，用ANSYS13.0 CFX软件模拟虹吸部血流动力学。

观察正常血流及血管硬化狭窄后对血流动力学的改变，分析其对动脉粥样硬化的影响。

结果颈内动脉虹吸部解剖形态分四型：以“U”、“V”多见，分别占53%（148/280），30%(84/280)；“C”型、“S”少见，共占17%（48/280）。

颈内动脉虹吸部钙化分布：C4段外弯钙化96例（96/352），占总数27%，内弯段钙化58例（58/352），占总数16%。

C5段外弯钙化48例（48/352），占总数14%，内弯段钙化67例（67/352），占总数19%。

C6段外弯钙化48例（48/352），占总数14%，内弯段钙化35例（35/352），占总数10%。

两组患者年龄统计结果为正常组（70例）年龄59.17±10.27岁，钙化组为（70例）67.39±9.32岁；t 检验结果为：年龄t = 9.32 ，P < 0.05 ，两组有显著差别。

血管直径：正常组直径为4.29±0.63mm，钙化组为4.90±0.44mm；t = 1.610 ，P > 0.05 ，两组虹吸部血管大小无明显差别。

C4、C5段折角测量值：正常组（左右两侧，140例）C4折角为87.23±36.66 度，钙化组为（左右两侧，140例）84.30±37.35度；C5折角正常组（左右两侧，140例）为49.21±26.01度，钙化组为（左右两侧，140例）为54.57±24.16度。

两组t 检验，其结果为：C4折角t = 0.575 ，P > 0.05 ；C5 t = 24.16，P > 0.05，两者统计学处理无显著性差异。

颈内动脉正常管腔血流动力学特点：血流在弯曲的虹吸部内仍呈层流状态，但经过两个折角时血流发生旋动，血流在外弯速度较慢，内弯速度较快。

管壁剪切力以外弯低，内弯高。

动脉硬化狭窄后血流动力学特点为：动脉粥样斑块引起血管狭窄，斑块下游形成湍流及低剪切力区；狭窄程度增大，血流湍流、低剪切力区扩大，向心性狭窄较偏心性狭窄血流湍流、低剪切力区更明显。

结论颈内虹吸段解剖形态以“U”、“V”多见、以“C”、“S”型少见，钙化以C4外侧弯最多见。

钙化与年龄关系密切，年龄越大，动脉钙化发生率越高。

血流与血管的几何形态密切相关，弯曲形态影响管壁剪切力，导致血流发生旋动；狭窄后低剪切力、湍流可能诱发动脉粥样斑块、钙化形成，以向心性狭窄明显。

血流旋动具有抗动脉硬化作用，有重要的临床研究价值。

关键词：颈内动脉；解剖；狭窄；有限元建模；血流动力学Imaging Anatomy and Hemodynamics Simulation of Siphon Segment in Internal Carotid ArteryAbstractObjective (1) Observing and measuring the segment of the internal carotid artery and siphon shape.(2) Comparing the calcification distribution of Carotid and Siphon Segment of Internal Carotid Artery between normal group and sclerosis group.（3）Imitating the normal character of hemodynamic the normal Carotid and Siphon Segment of Internal Carotid Artery, and the change of hemodynamic after Atherosclerotic Plaque, comparing the two for the research of the relationship between the hemodynamic and siphon hardening.Methods （1）requirement of the object of study: patients aged above 50,who had CTA neck inspection in this hospital from January 2011 to December 2011. All patients divided into 2 groups: the normal group and the sclerosis group with 70 each. Rebuild the Siphon department blood vessels, observing the form of blood vessel,and measuring the break angle of C4、C5,and the diameter of blood vessel, to get the difference of the two.（2）To have finite element modeling on the basis of the CA T data, imitating Siphon department hemodynamic with ANSYS13.0 CFX software. Observing the normal blood flow and the change caused by Stiffblood vessels, analysing the effect to the atherosclerosis.Results （1）According to the anatomic classification of the siphon, the ICA shape could be classified into 4 types: the “U” shape accounting for 53%(148/280) and the “V” shape accounting for 30%(84/280) are mostly common; and the “C”、“S” shapes are rare and only accounting for 17%(48/280)together. Diameter of blood vessel:4.29±0.63mm in the normal group, and 4.90±4.44mm in the sclerosis group,t = 1.610 ，P > 0.05. There is no difference in Siphon department blood vessels between the 2 groups.Break angle of C4、C5: C4 value 87.23±36.66 in the normal group, and 87.23±36.66 in the sclerosis group.T inspection of 2 groups,the result is:break angle of C4 is t = 0.575 ，P > 0.05 ；C5 t = 24.16 ，P > 0.05, no significant differences in the statistical treatment. diameter t = 1.610，P > 0.05, no significant differences in the statistical treatment. Age of patients involved in the 2 groups: age 59.17±10.27 in the normal group and 67.39±9.32 in the sclerosis group, with the result: age t = 9.32 ，P < 0.05, no difference between the two.Calcification distribution of Carotid and Siphon Segment of Internal Carotid Artery: C4 excurvature calcification 96 cases（96/352）,account for 72%, and inturn calcification 58 cases （58/352），account for 16%. C5 excurvature calcification 48 cases（48/352）,account for 72%, and inturn calcification 67 cases （67/352），account for 19%. C6 excurvature calcification 48 cases（48/352）,account for 14%, and inturn calcification 35 cases （35/352），account for 10%.(2) Character of the normal lumen hemodynamics of internal carotid: blood flow in the crooked siphon department still in laminar conditions, but after 2 break angles it will swirl, and the blood flow slow down in excurvation, but accelerates in the incurvature. excurvation hige and incurvature low in tube shear force. Character of hemodynamic after arteriosclerosis narrowed: Atherosclerotic Plaque caused the blood vessel narrow, which have secondary effects on flood flow, form turbulent flow and low shear force area in the lower reaches of plaque, the more stenosisthe more turbulent the blood flow is, and Concentric stenosis effects more to the hemodynamics than the Eccentric stenosis.Conclusion The anatomic shapes of carotid and siphon segment of internal carotid artery including 4 types: the “U”、“V” shapes are mostly common, and the “C”、“S”shapes are rare. Calcification pathological changes occur most often in C4 lateral curved. Atherosclerotic Plaque has close connection with age that the incidence is getting higher when people get older. Blood flow and the morphology of vessel areclosely related: the vascular bending shape would have effects on shear force of vessel wall and cause the blood flow turbulence low induce the formation of the Atherosclerotic Plaque and calcification, especially the eccentric stenosis. The swirl of the blood flow with an effect of Anti Atherosclerosis Actions is important to the clinical research.Key words: Internal carotid; Anatomy; Stenosis; Finite element modeling; Hemodynamics第一部分颈内动脉虹吸部影像解剖颈内动脉粥样硬化导致血管狭窄与许多因素有关，主要有年龄、性别、高血压、糖尿病和高脂血症等。