|
|
- 2018
瘢痕子宫破裂影响因素的有限元分析
|
Abstract:
摘要 目的:以往对瘢痕子宫能否经阴分娩的研究主要是通过超声评估.本研究应用有限元法分析瘢痕厚度、瘢痕长度和材料特性对瘢痕子宫受力的影响,探讨瘢痕子宫经阴分娩时的破裂预警.方法:应用SOLIDWORKS建立足月瘢痕子宫的三维模型,对该模型进行ANSYS仿真分析并验证.结果:在宫缩过程中,厚度越小瘢痕处应力越大越易破裂;以3 mm作为子宫前壁厚度的边界值,若测量厚度大于界值可以考虑经阴分娩,反之易发生子宫破裂应选择剖宫产;在施加同一内压下,瘢痕越长,瘢痕所受应力越大,子宫越易破裂;杨氏模量太小或者太大,都导致瘢痕所受应力增大.结论:经敏感性分析得出瘢痕厚度对子宫破裂影响最大,瘢痕长度和材料特性影响较小.基于ANSYS仿真分析以一种新的角度研究了瘢痕子宫破裂的影响因素,为瘢痕子宫能否选择经阴分娩提供客观分析方法和临床指导.
| [1] | 周萌,尹协振,童秉纲.鲫鱼皮肤和肌肉的力学性能研究[J].实验力学,2010,25(5):536-545. |
| [2] | ZHOU M,YIN X Z,TONG B G.Study on mechanical properties of carp skin and muscle[J].Journal of Experimental Mechanics,2010,25(5):536-545. |
| [3] | NAJI O,ABDALLAH Y, BI J D.Standardized approach for imaging and measuring Cesarean sectionscars using ultrasonography[J]. Ultrasound Obstet Gynecol,2012,39(3):252-259. |
| [4] | 王马列,梁润彩.阴式手术治疗剖宫产术后子宫切口憩室53例疗效观察[J].暨南大学学报(自然科学与医学版),2013,34(4):417-420. |
| [5] | 葛安娜. 孕妇乘员计算机模型的建立及其保护措施的改进研究[D].长沙:湖南大学,2006:20-22. |
| [6] | 吴景平,尚雅琼.186例瘢痕子宫妊娠后的分娩方式分析[J].中国妇幼保健,2014,29(8):1177-1179. |
| [7] | WU J P,SHANG Y Q.Analysis of delivery methods in 186 cases of scar uterus after pregnancy[J].Chinese Maternal and Child Health Care, 2014,29(8):1177-1179. |
| [8] | 乐杰. 妇产科学[M].6版. 北京:人民卫生出版社,2004:230-232. |
| [9] | XIAO H Q.Research on protection measures for pregnant women occupants[D]. Changsha:Hunan University, 2011:18-21. |
| [10] | DUCK. Physical Properties of Tissue[M].London:Academic Press,1990:355-356. |
| [11] | WANG Y H.Ultrasonic evaluation of uterine scar healing after cesarean section and its influencing factors[D].North China University of Technology,2016:7-9. |
| [12] | 郭培奋,刘芳,王彩霞.子宫壁的力学特性及调节机制[J].分子影像学杂志,2016,39(2):183-185. |
| [13] | GUO P F, LIU F,WANG C X.Mechanical properties and regulation mechanism of uterine wall[J].Journal of Molecular Imaging,2016,39(2):183-185. |
| [14] | LE J.Obstetrics and gynecology[M]. 6th ed. Beijing: People's Medical Publishing House, 2004: 230-232. |
| [15] | 刘强,刘华倩,孙雪冰.子宫破裂的高危因素及诊疗现状Ⅲ[J/OL].中华临床医师杂志:电子版,2013,7(22):10315-10320. |
| [16] | WANG M L,LIANG R C.Effect of vaginal surgery on 53 cases of uterine incision diverticulum after cesarean section[J].Journal of Jinan University(Natural Science & Medicine Edition),2013,34(4):417-420. |
| [17] | 李向农,张春柳,和朝平.经阴道彩超评价剖宫产术后子宫切口愈合情况的临床研究[J].中国误诊学杂志,2008,(19):4540-4542. |
| [18] | GE A N.The establishment of computer model for pregnant women occupants and improvement of protection measures[D]. Changsha:Hunan University, 2006:20-22. |
| [19] | 肖慧青. 孕妇乘员保护措施研究[D].长沙:湖南大学,2011:18-21. |
| [20] | CONRAD J T,KUHN W K,JOHNSON W L.Stress relaxation inhuman uterine muscle[J]. American Journal of Obstetrics and Gynecology, 1966, 95(2): 254-265. |
| [21] | WOOD C.Physiology of uterine contractions[J].British Journal of Obstetrics and Gynecology, 1964,71: 360-373. |
| [22] | MANOOGIAN S, BISPLINGHOFF. Dynamic material properties of the pregnant human uterus[J]. J Biomech, 2012,45(9):1724-1727. |
| [23] | 陈倩倩. 子宫附属韧带维持子宫正常位置的有限元仿真研究[D].上海:复旦大学,2014:14-15. |
| [24] | CHEN Q Q.Finite element simulation study of uterine accessory ligament maintaining normal position of uterus[D]. Shanghai: Fudan University, 2014:14-15. |
| [25] | 谢幸,苟文丽.妇产科学[M].8版.北京:人民卫生出版社,2013,3:187-191. |
| [26] | XIE X,GOU W L.Obstetrics and gynecology[M]. 8th ed. Beijing: People's Medical Publishing House, 2013.3: 187-191. |
| [27] | 贾利英,孟文颖,马海会,等.妊娠子宫破裂的临床分析[J].中华医学杂志,2013, 93(33): 2674-2676. |
| [28] | JIA L Y, MENG W Y, MA H H,et al.Clinical analysis of uterine rupture in pregnancy[J]. Chinese Journal of Medicine, 2013, 93(33): 2674-2676. |
| [29] | 葛岩. 首次剖腹产切口的选择对二次剖腹产手术的影响[J].中国卫生标准管理,2017,8(8):55-57. |
| [30] | GE Y.Effect of the choice of first caesarean section on the second caesarean section[J].Chinese Health Standards Management,2017,8(8):55-57. |
| [31] | 王艺桦. 超声评估剖宫产后子宫瘢痕愈合情况及其影响因素分析[D].华北理工大学,2016:7-9. |
| [32] | 张翼婷,张羡,王晓玉.剖宫产切口疤痕妊娠40例结局分析[J].暨南大学学报(自然科学与医学版),2013,34(6):632-635. |
| [33] | ZHANG Y T,ZHANG X,WANG X Y.Analysis of 40 cases of cesarean section incision scar pregnancy[J].Journal of Jinan University(Natural Science & Medicine Edition),2013,34(6):632-635. |
| [34] | 王彩霞,郭培奋,胡晴丽.剖宫产术后不同年限子宫瘢痕的组织学与力学特征观察[J]. 武警医学,2015,29(9):900-903. |
| [35] | WANG C X, GUO P F, HU Q L.Histological and mechanical characteristics of uterine scars in different years after cesarean section[J]. Armed Police Medical, 2015, 29(9): 900-903. |
| [36] | LIU Q,LIU H Q,SUN X B.High risk factors of uterine rupture and current status of diagnosis and treatment III[J/OL]. Chinese Journal of Clinicians: Electron, 2013, 7(22): 10315-10320. |
| [37] | 傅绢,黄国诚,徐利云.阴道超声观察剖宫产术后子宫切口愈合情况的临床价值[J]. 中国妇幼保健,2004,19(22): 64-65. |
| [38] | FU J,HUANG G C,XU L Y.Clinical value of vaginal ultrasound in the observation of uterine incision healing after cesarean section[J]. Journal of Maternal and Child Health Care,2004,19(22): 64-65. |
| [39] | LI X N,ZHANG C L,HE C P.Clinical study on the healing of uterine incision after cesarean sectionby by transvaginal color Doppler ultrasound[J].Chinese Journal of Misdiagnosis,2008,(19):4540-4542. |
