Indlela yokuCatshulwa kweNtsalane yokuTyekiswa kweNtsholongwane yokuThengisa iNgxenye I

UkuCatshulwa koLawulo lweSifo:

• Umlomo wesibeleko kunye ne-radiographic variances isifo esifana
• Umlomo wesibeletho
• Arthritis
• Neoplasms
• Sulelo
• I-Post-Surgical cervical spine

• Ukuzinza kwe-Cranio-kervical and upper colervus kuxhomekeke kumagqabantshintshi aphezulu, aphezulu kunye angaphantsi kweLiLIMUMX-C1 ligament, iiglaments e-alarm, kunye nezinye iimbambano ezimbalwa

Ingxaki yomlomo wesibeleko

• I-C / S isengozini yokulimala. Ngoba?
• Uzinzo luye lwabanjelwa ukuhamba okukhulu
• I-vertebrae yesibeleko incinci kwaye iphazamisekile ngama-foraminae amaninzi
• Intloko ayixhomekekanga kwaye isebenza njengeqhenqa elingavumelekanga ngokukodwa xa imikhosi isebenzela isantya esinzima
• Ukongezelela, iC / S ifanelekile ekuhlaleni okwenza kube yingozi kakhulu kwintlungu
• Kubantwana abancinci, iigamente zithandeka ngokubhekiselele kumlinganiselo omkhulu wenhloko
• Kubantwana, i-fulcrum yentembeko i-C2 / 3 ngaloo ndlela yenza ukulimala okuqhelekileyo kwi-C / S ephezulu kunye kunye ne-craniocervical junction. Kubantwana, i-SCIWORA iyakwenzeka xa kungekho ubungqina bokuphuka
• Kubantu abadala, i-fulcrum yentembeko i-C5 / 6 ngaloo ndlela yenza i-C / S engaphantsi kweyona nto ingasetyenziselwa ukuxhatshazwa ngokugqithiseleyo ngexesha lokugqithisa
• Umlomo wesibeleko uhlelwe ngokweendlela zokulimala (ulwahlulo lweHarris kunye neMirvis)

Ukutshatyalaliswa kwe-Hyperflexion Ukulimala: Uzinzile kunye nokungaqiniseki

• I-Flexion teardrop Fx (inqabileyo eninzi, engazinzi)
• Ukutshatyalaliswa kwezinto ezinobungozi (ukulimala kanzima w / o ukuphazamiseka, okungaqinisekiyo)
• Ukuhlukunyezwa kwangaphambili (okungenakho ukuzinza) kunokuba yingozi kakhulu
• I-Clay Shoveller Fx (ukunyuswa kwe-C / S engezantsi, ukuzinza)
• Ukunciphisa okulula okulula (ubuninzi be-Fx, bomelele)
• Ukutshintshisiswa kwe-Hyperflexion nge-unilateral facet dislocation
• Fumana imbali epheleleyo
• Ukuqhuba uvavanyo lomzimba kubandakanya ukuhlolwa kwegazi
• Qwalasela iinqobo ze-NEXUS (kuZwelonke Emergency X-radiography Isifundo sokusetyenziswa)

Iindlela zokucinga:

• Uqala nge x-radiography ngokukodwa kwiziganeko ezingenayo ingxaki enkulu ye-neurological compromise
• Ukujonga okungekho mbambano kwiphondo yokuqala
• Ukuba x-radiografi ingaphenduli kodwa ubukhulu obuphezulu beentlungu ezibuhlungu kunye nokulahleka kweengqondo, i-CT scanning w / o iyafuneka
• Cinga ukutshekisha kwe-CT kwizigulane ezineentshintsho zangaphambili: i-spondylosis yangaphambili, i-DISH, AS, i-RA, umgudu osemva kokuvuthwa, ukungavumelekanga kokuzalwa (i-Klippel-Feil syndrome, njl.

Ukunyanzeliswa okuqhelekileyo:

• IJefferson yaqhambuka iAlaslas Fx (engaqinisekiyo xa i-ligament Transverse iqhekekile, intambo yokukhubazeka kwi-20-30% kuphela)
• Ngoba? Ngenxa yokuqhekeka kweengcezu kunye nelayali
• Ukugqithiswa kweFx kwiTraracic okanye iLumbar umgudu (ongaqinisekanga, intambo yokukhubazeka ingenzeka)

Indlela yokuvavanya ama-Radiographs kwiziganeko ze-Trauma:

• Yakha i-5-imigca kwi-viewal view
• Qaphela ukuba iinkalo zihambelana kakuhle kwaye zihambelana
• Qinisekisa ukulinganisa kwe-disk height
• Phawula naluphi na ukwandisa okanye ukutshisa umgama ophakathi
• Ukuqwalasela ngokucophelela izicubu ezithambileyo ze-prevertebral
• Hlola i-atlanto-yamazinyo ekhefu (ADI)

• Kwiimeko zexinzelelo, hlalutya kwaye kucace engathathi hlangothi kuqala
• Musa ukwenza imibono eguquguqukayo kunye nokwandiswa kwamacala kwiimeko ezinzima ngaphambi kokuba i-ray-ray okanye i-CT scanning ingabandakanyi ukungazinzi okukhulu
• Nika ingqalelo kwii-tissue ezithambileyo zangaphambili
• Ukuba kunomda ogqithiseleyo kunomda oqhelekileyo, qwalasela i-post-traumatic bleed
• I-asymmetry efihlakeleyo kunye nokwandisa ukuphakama kwe-disk posterior kunye neenkalo kunye nokukhwaza kwangaphakathi kwintsikelelo kungaba yinto ebalulekileyo yokwehliswa okukhulu kwegigamente

Ukulimala kwe-Hyperflexion (M / C Mechanism)

• Okuqhelekileyo rhoqo kwi-C-S C-3-C7 kwi-axial
• Ukulimala okungaqinisekiyo:
• Ukuqhekeka kwethontsi (I-M / C C5 kunye ne-C6) v. Ayizinzanga
• Iinkalo ezibalulekileyo:

• I-"tardrop" enkulu ebunxantathu yomzimba
• Ukutshitshiswa kwe-SPs, i-disc yangemva kwendawo kunye nobubanzi bebakala obubonisa ukutyunjwa kwamagqabantshintshi amakhulu kunye nokungazinzi
• Ukutshintshwa kwendawo engaphezulu komzimba we-vertebral fracture kuphakamisa intambo yangaphambili yomgca / izitya zokunciphisa
• Ukuqhaqhazela izicubu ezinotsholongwane ze-prevertebral> 20-mm kwi-C6-7
• I-80% yamatyala inokukhubazeka kwindawo okanye ivelise ukukhubazeka okufutshane emva kwangoko

I-Acute Neck Trauma. Ziziphi iimpawu ezibalulekileyo ze-radiographic? Yintoni ukuxilongwa?

• I-CT scanning w / o ihluke ngokutsha kwakhona. Qaphela iC7 Flexion teardrop Fx.
• I-CT inokunceda ngokucwangcisa phambili kunye nokucwangcisa kwangaphambili
• Ngamana ungalandela noM MR ukucinga kunye nokuvavanya ukulimala kwegazi

• Isalathisi se-Fluid (T2) se-sagittal sRI ye-Flexion ye-Flexion evulekile kwiC4 kwaye mhlawumbi i-C5
• Qaphela isilonda esiphezulu sesiginci sekhondlo kwintambo kunye nemigqa ejikelezayo ebonisa i-edema yentambo kunye ne-ischemia
• Ulawulo: i-neurosurgical ne-fusion fusion
• Iingxaki:
• Quadriplegia / paraplegia
• Iingxaki zokuphefumula
• Ukukhubazeka, utshintsho kwimgangatho wobomi
• Ukunciphisa ixesha lokuphila

• I-facetary facet dislocation (engazinzi)
• Indlela: Ukulimala-ukuphazamiseka kokuphazamiseka
• Idrafrikhi ebalulekileyo: umzi womntu ophumayo ngaphandle kwe50% okanye ngaphezulu
• Iimpawu zigqithise kwaye zivalelwe (zinokuthi zifakwe kumfanekiso osekhohlo)
• Ukugqithwa okukhulu kwegamente
• Amathuba okuncinci kwentambo kunye nokukhubazeka
• Izigulane ezinegigamentsxakeli kunye neenguqu ezitshintshayo zisesifo esiphezulu
• Ukuqala x-radiography isinyathelo sokuqala

I-CT scanning w / o Ukwahlula kubalulekile:

• Ukucaciswa okuqhubekayo kwesi sikalo
• I-facet fractures, i-pedicle fracture
• Ucwangciso loLawulo

I-Sagittal fluid i-MRI enovelwano ye-bilateral C5 facet dislocation, i-ischemic cord ye-ischemic ukwenzakala, kunye nokulimala kwezicubu ezithambileyo zangasemva.

• Ulawulo:
• I-X-radiography, ngoko-CT ukuhlaziya ngokukhawuleza ukuvalwa (umzekelo ukuba isiguli siyazi)
• Ilandelwa kwezinye iimeko ezilukhuni nge-MRI kwaye unyango lokunyangwa
• Ukuba isigulane siphaphekile kwaye sizinzile ngokwemvelo, i-CT kunye nokunciphisa ukuvalwa kuyanele
• Amathambo anzima kwaye ayiphumelelanga ukunciphisa ukuvalwa kungadinga ukuzinzisa ukuzinzisa
• Iingxaki: umqolo ukulimala nokukhubazeka
• Ukulahla ukuxilwa kunye nokungazinzi

• • Unilateral facet dislocation (inzakalo yokujikeleza kwesikhumba) kunzima kakhulu kunokuba ukuxhatshazwa kwamanye amazwe
  • Ubuninzi obunokukhubazeka komlomo wesibeleko kwi-x-rayography
  • Iinkalo ezibalulekileyo: umzimba uphendulelwe kwangaphambili i-25% iifom yefayile ibonakala ingacatshangwanga kwaye iphazamisekile, i-SP ijikelele kwimibono yangaphambili
  • Iikliniki inokuthi iboniswe njenge-radiculopathy eyodwa-side esp. C6 okanye iC7
  • I-scan scan iyadingeka ukuvavanya ezinye iifetric facet / fractures
  • Ukuphononongwa kwangaphambili kokunciphisa nokunyamekela
  • Ulawulo: Ukunciphisa ukuvalwa. kwisigulane esaziwayo
  • Iingxaki: ukukhutshwa kwe-acute disney / retropulsion, i-laxity ligament, ukulimala kwegazi

Indlela yokuTyela yokuTywala

Izibonelelo:

• emedicine.medscape.com/article/824380-overview
• emedicine.medscape.com/article/248236-overview#a9
• emedicine.medscape.com/article/397896-overview#a3
• www.aafp.org/afp/1999/p331.html