In the mountainous areas of Southwest China, a karst landscape is well developed. There, exposed giant karst caves in the construction of high-speed railway tunnels cause great construction difficulties and safety risks for the tunnel crossing. In this paper, the study object is the project on giant karst cave of the Qianjiang–Changde railway high-mountain tunnel. After the karst cave was revealed, unmanned aerial vehicle detection, three-dimensional laser scanning, and blasting vibration monitoring were used to study the stability of the karst cave. It was found that the karst cave has a higher risk of falling rocks. On the basis of careful consideration of construction, operation safety, and economy, the “backfill cave ballast + grouting to reinforce on the upper part” scheme was determined for the treatment of the karst cave. During the process of disposal, the surface and layered settlement of backfill were monitored, in which it showed that the surface settlement control was reasonable, and the settlement mainly came from the bottom of the grouting layer, the top of non-grouting backfill, and original accumulation. To prevent the risk of falling rocks, we performed permanent safety protection of the wall and the roof for the karst cave and temporary safety protection of the mobile scaffold. Finally, the backfill treatment of the giant karst cave of high-mountain tunnel was smooth, the settlement after construction was controllable, and it met the design requirements.
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