Creating Virtual Surgery Targets & Methods to Improve Outcomes of Nasal Surgery

描述（由申请人提供）：美国每年有超过340，000人接受手术以纠正鼻气道阻塞（NAO）。大约23-37%的手术未能纠正患者的症状。鼻外科手术的高无效率主要是由于缺乏 可以可靠地量化鼻功能并预测手术结果的工具。用于量化鼻功能的计算方法显示出显著的前景，但是缺乏关于哪些生物物理变量最好地预测症状变化、什么范围的客观值是规范的以及如何最好地制作外科医生可以用于为每个个体制定“正确”手术计划的虚拟手术工具的信息。在过去的四年中，我们探索了计算流体动力学（CFD）建模作为这一工具的潜在基础。我们创建了NAO患者调查的术前和术后数据库，基于计算机断层扫描（CT）的CFD模型，以及鼻部手术结果的计算机客观测量。我们发现某些CFD生物物理变量-鼻阻力，热通量和单侧气流-区分术前和术后状态，并与患者报告的症状最相关。我们还发现，试图复制实际手术的虚拟手术CFD模型产生的基于CFD的测量结果与基于实际手术模型的测量结果相似，从而提供了虚拟手术计划可行性的初步验证。 我们的长期目标是开发一种鼻虚拟手术工具，临床医生可以普遍使用，以改善患者的治疗效果。这一目标将逐步实现。第一步，确定跟踪患者症状的生物物理变量，是由我们先前的研究完成的。第二步，这是更新的建议的目标，是确定这些变量的标准值作为手术的目标，开发方法来优化虚拟鼻手术，并探讨虚拟手术建模对外科医生决策的影响。未来的步骤将包括为临床医生创建用户友好的虚拟手术软件，以及一项前瞻性临床试验，以确定虚拟计划引导手术是否比当前的护理标准MoE成功。我们的中心假设是，NAO手术的当前护理标准可以通过使用虚拟手术工具来设计个性化的鼻部解剖结构来改善，该解剖结构通过针对正确的手术类型和手术量来优化鼻部功能。

DESCRIPTION (provided by applicant): Over 340,000 people in the US have surgery to correct nasal airway obstruction (NAO) annually. Approximately 23-37% of these surgeries fail to correct patients' symptoms. The high inefficacy rate of nasal surgery is largely due to the lack of tools that can reliably quantify nasal function and predict surgical outcomes. Computational methods for quantifying nasal function show significant promise, but information is lacking on which biophysical variables best predict symptom changes, what ranges of objective values are normative, and how best to make a virtual surgery tool that surgeons can use to develop the "correct" surgical plan for each individual. During the past four years, we explored computational fluid dynamics (CFD) modeling as a potential basis for this tool. We created pre- and post-surgery databases of NAO patient surveys, computed tomography (CT) scan-based CFD models, and computed objective measures of nasal surgical outcomes. We found that certain CFD biophysical variables - nasal resistance, heat flux, and unilateral airflow - discriminated between pre- and post-surgery states and correlated best with patient-reported symptoms. We also found that virtual surgery CFD models that attempted to replicate the actual surgery produced CFD-based measurements similar to those based on actual surgery models, thus providing the initial validation that virtual surgery planning is feasible. Our long-term goal is o develop a nasal virtual surgery tool that will be universally accessible to clinicians to improve patient outcomes. This goal will be accomplished in a stepwise fashion. The first step, identifying biophysical variables that track with patient symptoms, was accomplished by our prior study. The second step, which is the goal of this proposal for renewal, is to determine normative values for these variables as targets for surgery, develop methods to optimize virtual nasal surgery, and to explore the impact of virtual surgery modeling on surgeon decision-making. Future steps will include the creation of user-friendly virtual surgery software for the clinician and a prospective clinical trial to determine if virtual planning-guided surgeries are moe successful than the current standard of care. Our central hypothesis is that the current standard of care for NAO surgery can be improved by using a virtual surgery tool to design individualized nasal anatomy that optimizes nasal function by targeting the correct type and amount of surgery.