利用有限元分析预警经阴道分娩瘢痕子宫破裂风险  

Rupture Warning of Scar Uterus in Vaginal Delivery by Finite Element Analysis

作　　者：马新刚[1] 于迎春[1] 孟颜颜 贺磊[2] MA Xingang;YU Yingchun;MENG Yanyan;HE Lei(Department of Surgical Anaesthesia,Zibo Maternal and Child Health Hospital,Zibo 255000,Shandong,China;School of Mechanical Engineering,Shandong University of Technology,Zibo 255000,Shandong,China)

机构地区：[1]淄博市妇幼保健院手术麻醉科,山东淄博255000 [2]山东理工大学机械工程学院,山东淄博255000

出　　处：《医用生物力学》2021年第1期92-95,共4页Journal of Medical Biomechanics

基　　金：淄博市科技发展计划项目(2016kj010029)。

摘　　要：目的应用有限元法分析瘢痕子宫受力与瘢痕厚度及位置的关系,研究瘢痕子宫破裂风险因素。方法首先基于孕期为40周孕妇子宫尺寸应用Solid Works建立瘢痕厚度和位置可变的子宫三维模型,然后在ANSYS软件中设置宫内压力,压力范围为4.83~23.9 k Pa,计算子宫受力。结果在宫缩过程中,最大应力位于子宫瘢痕处,瘢痕厚度低于3 mm子宫所受最大应力大于子宫抗拉强度;以3 mm作为子宫下体厚度界限,若测量厚度小于3 mm,子宫破裂应立即选择剖宫产,反之可以选择经阴分娩;当瘢痕厚度为3.0 mm时,子宫所受最大应力随着与子宫底距离的增加先减小后增大,在距离子宫底295 mm时子宫瘢痕处的应力最小;瘢痕距离子宫底为285~305 mm时,瘢痕所受极限应力小于其抗拉强度,选择顺产比较安全。结论基于ANSYS有限元分析研究瘢痕子宫破裂风险因素,分析结果与临床资料相符,为临床中分娩方式的选择提供分析方法和理论指导。Objective To analyze the relationship between scar uterine stress and scar thickness/position by using finite element method,so as to study risk factors of scar uterus rupture. Methods Firstly,SolidWorks was used to establish a three-dimensional( 3D) model of the uterus with variable scar thickness and position based on uterine size of the pregnant woman at 40^(th) week of gestation,and then the intrauterine pressure was set in the ANSYS software with pressure range of 4. 83-23. 9 kPa to calculate the uterine stress. Results During the contraction process,the maximum stress was located in uterine scar,the maximum stress on the uterus with scar thickness smaller than 3 mm was greater than tensile strength of the uterus;3 mm was used as thickness limit of the lower uterine body. If the thickness was smaller than 3 mm,cesarean section should be selected immediately. Otherwise,transvaginal delivery could be selected. When the scar thickness was 3. 0 mm,the maximum stress experienced by the uterus decreased at first and then increased with the distance from the uterine floor increasing. The stress at the uterine scar was the smallest when the distance from the uterine floor was 295 mm;when the scar was 285-305 mm from the uterine floor,the ultimate stress on the scar was smaller than its tensile strength,and it was safer to choose a vaginal delivery. Conclusions Risk factors of scar uterine rupture were studied based on ANSYS finite element analysis. The analysis results were consistent with the clinical data,which provided analysis method and theoretical guidance for the choice of delivery method in clinic.

关 键 词：瘢痕子宫 瘢痕厚度 切口位置 破裂预警 有限元分析 

分 类 号：R318.01[医药卫生—生物医学工程]