Investigation of ventriculoperitoneal shunt disconnection for hydrocephalus treatment.
Investigation of ventriculoperitoneal shunt disconnection for hydrocephalus treatment.
复制标题
DOI：
10.3171/2020.6.peds20454
复制
发表时间：
2021-02-01
期刊：
影响因子：
--
通讯作者：
Harris CA
中科院分区：
文献类型：
--
作者：
Zahedi S;Hudson M;Jin X;Garling RJ;Gluski J;Nowak C;Marupudi NI;Begeman P;Harris CA
本研究旨在更好地了解导致分流管机械故障的因素，包括分流管-瓣膜分离和分流管断裂。为了确定机械故障的根本原因，作者创建了一个台式机械模型来模拟分流系统上的机械应力源。为了测试分流断裂，在分流导管垂直于瓣膜的情况下，测试导管-瓣膜连接处的循环载荷。使用标准方法用Nurolon固定导管和瓣膜。这些商业系统被比作集成的导管和瓣膜(作为一个单元制造)。为了测试分流导管和瓣膜的完全分离/断开，使用Nurolon和Silk缝线进行了平行位移测试。最后，对导管的硬度进行了评估。所有的力学调查都是对A公司和B公司两个主要分流公司的分流进行的。循环加载试验发现，B公司的分流在平均4936±1725个循环(95%可信区间2990-6890个循环)后断裂，而A公司的分流在8000个循环后没有失效。平行移位研究表明，B公司的分流导管-瓣膜组合在平均拉伸32±5.68 mm(95%可信区间25.6-38.4 mm)后，使用Nurolon缝线完全断开，而A公司的分流导管-瓣膜组合没有使用丝线或Nurolon缝线分离。在硬度实验中，B公司的导管硬度为13.23±0.15N，显著高于A公司的6.16±0.29N(p<；0.001)。分流导管-瓣膜断开或断裂导致的机械分流失败是分流失败的重要原因。这项研究首次证明了机械硬度较小的分流导管与伸展时不太可能与瓣膜断开的分流导管之间的相关性，以及与瓣膜出口成一定角度时也不太可能撕裂的分流导管之间的相关性。作者建议对护理标准进行干预，试验不那么僵硬的导管以减少断开。
This investigation is aimed at gaining a better understanding of the factors that lead to mechanical failure of shunts used for the treatment of hydrocephalus, including shunt catheter-valve disconnection and shunt catheter fracture. To determine the root cause of mechanical failure, the authors created a benchtop mechanical model to mimic mechanical stressors on a shunt system. To test shunt fracture, cyclical loading on the catheter-valve connection site was tested with the shunt catheter held perpendicular to the valve. Standard methods were used to secure the catheter and valves with Nurolon. These commercial systems were compared to integrated catheters and valves (manufactured as one unit). To test complete separation/disconnection of the shunt catheter and valve, a parallel displacement test was conducted using both Nurolon and silk sutures. Finally, the stiffness of the catheters was assessed. All mechanical investigations were conducted on shunts from two major shunt companies, assigned as either company A or company B. Cyclical loading experiments found that shunts from company B fractured after a mean of 4936 ± 1725 cycles (95% CI 2990–6890 cycles), while those of company A had not failed after 8000 cycles. The study of parallel displacement indicated complete disconnection of company B’s shunt catheter-valve combination using Nurolon sutures after being stretched an average 32 ± 5.68 mm (95% CI 25.6–38.4 mm), whereas company A’s did not separate using either silk or Nurolon sutures. During the stiffness experiments, the catheters of company B had statistically significantly higher stiffness of 13.23 ± 0.15 N compared to those of company A, with 6.16 ± 0.29 N (p < 0.001). Mechanical shunt failure from shunt catheter-valve disconnection or fracture is a significant cause of shunt failure. This study demonstrates, for the first time, a correlation between shunt catheters that are less mechanically stiff and those that are less likely to disconnect from the valve when outstretched and are also less likely to tear when held at an angle from the valve outlet. The authors propose an intervention to the standard of care wherein less stiff catheters are trialed to reduce disconnection.