舌骨自然位置和手术复位对上气道通畅的影响:计算有限元模型研究。

IF 3.3 3区 医学 Q1 PHYSIOLOGY
Journal of applied physiology Pub Date : 2024-12-01 Epub Date: 2024-11-07 DOI:10.1152/japplphysiol.00657.2024
Diane Salman, Jason Amatoury
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引用次数: 0

摘要

阻塞性睡眠呼吸暂停(OSA)患者的舌骨基线位置较低,这导致了手术舌骨复位(SHR)治疗,但治疗效果却大相径庭。基线舌骨位置(BHP;表型)和SHR对上气道(UA)功能的影响仍不清楚。我们的目的是利用计算模型研究它们对上气道的影响:方法:我们建立了一个经过验证的兔子上气道有限元模型,并利用该模型模拟了BHP和SHR单独或共同发生的变化。舌骨在头颅、尾部、前部、头颅前部和尾部前部方向发生 1-4 毫米的位移。模型结果包括使用闭合压力(Pclose)测量的 UA 可塌陷性、横截面积(CSA)和软组织力学(位移、应力和应变):结果:分级 BHP 增量增加了所有方向的 Pclose,在 4 毫米处增加了 29-43%(相对于原始 BHP)。基于前部的 SHR 降低了 Pclose(4 毫米处~-115%),增加了 ΔCSA(4 毫米处~+35%)。头颅SHR降低了ΔPclose(-29%),对CSA的影响很小。尾侧 SHR 增加了 ΔPclose (+27%),减少了 ΔCSA(-7%)。前颅和前尾SHR产生的应力和应变最大。SHR对UA结果的影响取决于BHP,尾部BHP越多,手术效果越差:结论:BHP(表型)和SHR都会改变UA结果,其影响取决于舌骨移位的方向和幅度。BHP会影响SHR降低UA塌陷的效果。这些发现进一步揭示了舌骨在UA通畅性中的作用,并表明考虑舌骨的基线位置和手术复位方向/增量可能有助于改善治疗OSA的舌骨手术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Influence of natural hyoid bone position and surgical repositioning on upper airway patency: a computational finite element modeling study.

The hyoid bone's inferior baseline position in obstructive sleep apnea (OSA) has led to surgical hyoid repositioning (SHR) treatment, yet outcomes vary widely. The influence of baseline hyoid position (BHP; phenotype) and SHR on upper airway (UA) function remains unclear. We aimed to investigate their impact on the UA using computational modeling. A validated finite element model of the rabbit UA was advanced and used to simulate changes in BHP and SHR, alone and in combination. The hyoid was displaced in cranial, caudal, anterior, anterior-cranial, and anterior-caudal directions from 1 to 4 mm. Model outcomes included UA collapsibility, measured using closing pressure (Pclose), cross-sectional area (CSA), and soft tissue mechanics (displacement, stress, and strain). Graded BHP increments increased Pclose for all directions and up to 29%-43% at 4 mm (relative to the original BHP). Anterior-based SHR decreased Pclose (approximately -115% at 4 mm) and increased ΔCSA (approximately +35% at 4 mm). Cranial SHR decreased ΔPclose (-29%), minimally affecting CSA. Caudal SHR increased ΔPclose (+27%) and decreased ΔCSA (-7%). Anterior-cranial and anterior-caudal SHR produced the highest stresses and strains. SHR effects on UA outcomes were dependent on BHP, with more caudal BHPs leading to less effective surgeries. In conclusion, BHP (phenotype) and SHR both alter UA outcomes, with effects dependent on hyoid displacement direction and magnitude. BHP influences the effectiveness of SHR in reducing UA collapsibility. These findings provide further insights into the hyoid's role in UA patency and suggest that considering the hyoid's baseline position and surgical repositioning direction/increment may help improve hyoid surgeries for OSA treatment.NEW & NOTEWORTHY Using computational modeling, this study directly shows that any shift from the healthy natural hyoid bone position increases upper airway collapsibility. Surgical hyoid repositioning alters upper airway outcomes in a direction- and magnitude-dependent manner, with its effects influenced by the natural hyoid position. Accounting for both the natural hyoid position and individually prescribed surgical repositioning may enhance upper airway stability and improve outcomes in obstructive sleep apnea (OSA) treatment.

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来源期刊
CiteScore
6.00
自引率
9.10%
发文量
296
审稿时长
2-4 weeks
期刊介绍: The Journal of Applied Physiology publishes the highest quality original research and reviews that examine novel adaptive and integrative physiological mechanisms in humans and animals that advance the field. The journal encourages the submission of manuscripts that examine the acute and adaptive responses of various organs, tissues, cells and/or molecular pathways to environmental, physiological and/or pathophysiological stressors. As an applied physiology journal, topics of interest are not limited to a particular organ system. The journal, therefore, considers a wide array of integrative and translational research topics examining the mechanisms involved in disease processes and mitigation strategies, as well as the promotion of health and well-being throughout the lifespan. Priority is given to manuscripts that provide mechanistic insight deemed to exert an impact on the field.
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