主动脉夹层内膜片力学特征的临床意义及其在胸主动脉腔内修复术中的价值  

Mechanical characteristics of intimal flap in aortic dissection:Clinical significance and application in thoracic endovascular aortic repair

作　　者：任露霞 李浩正 王海博 孙毅 员鹏飞 吴明炜 熊江 Ren Luxia;Li Haozheng;Wang Haibo;Sun Yi;Yuan Pengfei;Wu Mingwei;Xiong Jiang(Department of Vascular Surgery,The First Medical Center of PLA General Hospital,Beijing 100853,China;School of Medical Technology,Beijing Institute of Technology,Beijing 100081,China)

机构地区：[1]中国人民解放军总医院第一医学中心血管外科,北京100853 [2]北京理工大学医学技术学院,北京100081

出　　处：《中国血管外科杂志(电子版)》2025年第1期22-28,共7页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：国家自然科学基金区域创新发展联合基金重点项目(U23A20484);国家自然科学基金面上项目(82170498);北京市自然科学基金重点研究专题(21Z30086);北京市科技新星计划交叉项目(20240484698)。

摘　　要：目的探究内膜片组织在主动脉夹层发展过程中生物力学变化特征的潜在临床意义及其在胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)应用的参考价值。方法研究获得28例人体主动脉夹层内膜片标本,依据发病到手术的时间分为急性期(≤14 d)、亚急性期(15~90 d)和慢性期(>90 d)。对不同组别的内膜片组织进行单轴拉伸实验,通过在方向和时间两个维度上观察内膜片组织的应力—应变曲线图、断裂应力和峰值弹性模量,比较其生物力学特征差异。结果所有内膜片组织条的应力—应变响应均表现为非线性曲线。在方向维度上,各期内膜片组织的周向断裂应力均显著大于轴向(P>0.05);时间维度上,不同时期的内膜片周向和轴向断裂应力差异无统计学意义(P>0.05)。对于峰值弹性模量,各期内膜片组织在方向和时间维度上的差异均无统计学意义(P>0.05)。结论主动脉夹层内膜片的周向断裂应力显著大于轴向,与主动脉夹层患者横向原发撕裂口的形成相关。支架移植物的径向支撑力与内膜片弹性能的不适配是TEVAR术后重塑不良和支架源性新发破口形成的可能因素。Objective To explore the potential clinical significance of biomechanical changes in intimal flap during the progression of aortic dissection and its application in thoracic endovascular aortic repair(TEVAR).Methods A total of 28 human aortic dissection specimens were obtained.Based on the time from onset to surgery,all intimal flap tissues were divided into acute phase(≤14 days),subacute phase(15-90 days)and chronic phase(>90 days).Uniaxial tensile tests were conducted on the corresponding intimal flap tissues.The stress-strain curves,fracture stress and peak elastic modulus of intimal flap tissues from different groups were observed in two dimensions,direction and time,to compare the biomechanical characteristics of intimal flap tissues.Results The stress-strain response of all intimal flap strips was characterized by nonlinear curves.In directional dimension,the circumferential fracture stress of the intimal flap was significantly higher than the axial stress across all phases(P<0.05).In the temporal dimension,there was no statistically significant difference in the circumferential and axial fracture stresses of intimal flaps in different periods(P>0.05).Regarding the peak elastic modulus,no statistically significant differences were observed in either directional or temporal dimensions across all phases for the intimal flap tissues(P>0.05).Conclusion The circumferential rupture stress of intimal flap in aortic dissection is significantly greater than the axial stress,which is associated with the formation of transverse primary tear.The mismatch between the radial support force of stent grafts and the elastic energy of the intimal flap may be a potential factor for poor aortic remodeling and the formation of stent-induced new tears after TEVAR.

关 键 词：主动脉夹层 内膜片 生物力学特征 胸主动脉腔内修复术 

分 类 号：R654.2[医药卫生—外科学]