Indlela yokuCamngca kweNtsholongwane yokuTyekiswa koTywala Ingxenye II

Ukulimala kweHyperextension

• I-Hangman's Fx yaphazamisa ispondylolisthe yeC2 ngokuhlukana kwe-pars interarticularis okanye i-pedicles (engaqinisekanga)
• I-MVA yinto ebalulekileyo kakhulu
• Indlela: i-hyperextension ephezulu ye-C / S efana neyokulunga (ayizange yabonwe kwaye abaninzi abantu bafa ngenxa ye-asphyxiation)
• Iipatriki eziqhelekileyo zinganciphisa i-PLL kunye ne-disc
• Ukulimala okuhlangeneyo: i-30% inezinye i-c-spine fx ngokukodwa i-Extension teardrop kwi-C2 okanye i-C3 ngenxa yokuvuswa kweBONKE
• Intambo yokukhubazeka ingabonakala kuphela kwi-25% ngenxa yokuqhekeka kweengcambu kunye nokukhula komsele

• I-Hangman fx kunye ne-teardrop yokwandisa
• Ukuguqulwa komlomo wesibeleko kunye nokuxuba kwangaphambili kuyona nto ibalulekileyo ngenxa yokungahambi kokuhamba nokunyamezela, ukunika iC / S lula ukuphuka
• Ukufanekisa: yokuqala x-radiography ngoko-CT eyanceda ukucacisa enye inzakalo efana ne-facet / pedicle Fx ngakumbi. I-MRI inokukunceda ukuba kunzima ukulimala kwe-Vertebral A.
• Ulawulo: ukuba uhlobo lwe-1 kwenzelwa ukunciphisa kunye nekhola eqinile kwii-4-6 iiveki, i-halo ibhala ukuba uhlobo lwe2 (> 3-5mm ukufuduka) Fx / ukungazinzi, ukuhamba kwangaphambili okanye kwithuba lokugcina umgcini we-C2-3 ukuba uhlobo 3 Fx (> 5 -mm ukuhamba)

 

 

• Ukwandisa i-teardrop Fx (izalathiso) ezinokuthi zizinzile xa zifakwa kwandiswa
• Ukuvuswa komzimba ongaphantsi komntu wonke. Kubonwa ngakumbi kwibadala kunye ne-C / S spondylosis
• I-radiography engundoqo: encinci yomzimba ongaphantsi komgangatho ongaphantsi, akukho ukuphazamiseka kokulungelelaniswa kwegilithi. Ngokuqhelekileyo kwi-C2 okanye i-C3 ngenxa ye-hyperextension ngokukhawuleza kunye NONKE ukuvuswa
• Inkcenkcesho: i-central cord syndrome (m / c engaphelelanga kwintambo yomnxeba) esp. kwi-spondylosis ephakamileyo kunye ne-canal stenosis ngokuxakeka kwe-ligamentum flavum kunye ne-osteophytes
• Ulawulo: ukukhutshwa kwekhola elukhuni

 

 

I-vertical (axial) Ukuxhatshazwa koxinzelelo

• UJefferson Fx (ogqitywe ngeBrithani neurosurgeon eyayichaza oko) (engaqinisekanga kodwa ene-neurologically fx Fx) 7% yazo zonke izilonda zeC / S. Ukuzinza kuxhomekeka ukuba i-ligament ehambayo ingenakunyaka okanye ichithwe, engabonwa ngokugqithisa kweMXMUMX emininzi ye-C1> 2-mm idibene (umfanekiso wesobunxele)
• Inkqubo: Ukunciphisa i-C1 (umz., Ukudibela emanzini angatyekanga) kubangele ukuqhuma kwe-Fx-classically 4-izingxenye zesigxina sangaphambili nangasemva kweC1. Utshintsho lukhoyo.
• Iingxaki: I-50% ibonisa enye iC / S Fx, i-40% ibonisa i-Odontoid C2 Fx esp. ukuba ukunyusa kunye nokukhutshwa kwe-axial kwenzeka

 

 

• Ukucinga: x-radiografi elandelwa ngu-CT ukuhlola ukulimala okuxhatshazwayo kunye nokuxakeka kokulimala kweC1. Qaphela iJefferson Fx kunye nensika kunye ne-transverse foramina fx edinga ukufuma kwe-post-occervital-fervical (ngaphantsi kwesithunzi esifanelekileyo).
• Ulawulo: i-collar immobili ukunyanzelisa ukuba i-ligament eguquguqukayo ingasebenzi. I-Halo brace okanye i-fusion ukuba i-ligament eguqukayo ichithwe

 

 

Izinyango Zesibeleko Ngeendlela ezihlukileyo zoxinzelelo

• Inkqubo ye-Odontoid fractures:
• Oku kwenzeka' ngeendlela ezahlukeneyo, ukuguquguquka, ulwandiso, ukuguquguquka kwecala. Abantu abadala abane-spondylosis ephezulu basengozini enkulu.
• Ukwahlula-hlula kukaAnderson & D'Alonzo (ngezantsi). Uhlobo lwe-2 lolona luqhelekileyo kwaye aluzinzanga. Uhlobo lwe-3 lunamathuba amahle okuphilisa i-d / t ngaphezulu kwegazi emzimbeni weC2 kunye nokunyanga okungcono.
• Ukucingela: x-radiography ilahleke iFx. I-scan scan ibalulekile.
• Kwinqanaba le-x-radiographie elikhupha i-Dens kwi-postal kunye ne-APOM. I-CT iya kubonisa ukulimala nokuyibeka.
• Iingxaki: intambo yokulimala, ukungabambisani

 

 

• I-CT scan: Uhlobo lwe-2 lwentsimbi (engaqinisekiyo)
• Ulawulo: uhlobo lwe-1 (i-alar ligament avulsion) eyona nto izinzile �ijongwe kwaye iphathwe ngekhola eqinileyo.
• Kwizigulane eziselula, i-Halo brace isetyenziselwa ukuphatha uhlobo lwe-2
• Izigulane ezigugu azibekezeli iHalo
• I-Fusion C1-2 fusion xa engaqinisekiyo i-Dx kunye nempawu zentambo okanye ezinye izinto ezinzima zikhoyo

 

 

Iindidi eziqhelekileyo zeRadiographic & Anomalies Simulating Pathology

• Lwezonyango umqolo ibonakala eyahlukileyo ngakumbi kwi abantwana ncinane kuneminyaka eyi-10.
• Uhlobo oluqhelekileyo; I-ADI 5-mm kwaye inokunyuka okanye iyancipha kwizinto eziguquguqukayo / ezongeziweyo nge-1-2-mm
• I-C2-3 ingabonakala njengengqamaniso-ngxowankulu ngenxa yokugqithiswa kwesigxina esilulayo kubantwana (ngaphantsi komcibisholo)
• Izidumbu zezilwanyana zentsholongwane zihlala zincinci kwaye zitshatiwe kwangaphambili ngenxa yobunzima beethambo

• Ukujonga kwe-APOM kubonakala kuhluke kubantwana, kwaye i-asymmetry ye-C1 yoluntu yinto eqhelekileyo (ngaphantsi komfanekiso ophezulu) kwaye akufanele idideke noJefferson Fx
• Kubantu abadala, nayiphi na i-asymmetry okanye "inqwaba" yezixuku ze-C1 i-patticical and can indicate Jefferson fx

 

 

• Amagumbi ase-Standard ossification ase-Atlas synchondrosis kubantwana akufanele aphutyiwe ngenxa yeentsimbi

 

 

• Isiphelo se-ossiculum esingapheliyo saseBergman sisininzi / sichaphazelekayo kwisikhungo esisihlangeneyo se-ossification kwaye akufanele sidideke kunye nohlobo lwe-fx

• Os odontoideum
• Isikhungo sokukhula esihlangeneyo esisabonwa njengengozi engabonakaliyo ephazamise ukukhula okuqhelekileyo kumntwana omncinci kuneminyaka eyi-5
• Ingaba yimbangela ye-C1-2 engazinzekanga kwaye kufuneka ihlolwe ngokubonisana nezimo zomlomo
• Akufanele kudideke ngohlobo lwe-2 Ukuphulwa kweentshukumo ngenxa yokuba ngokubanzi kubonisa ukugqithisa okukhulu kwethambo

 

 

• I-agenesis engapheliyo ye-C1 emva komgca
• Ukuvalwa kwe-Anomalous ye-C1 emva komgca
• Akufanele idideke kunye neqhekeza
• Nangona kunjalo, iimpawu zengingqi okanye intambo zingathuthuka emva koxinzelelo kwezinye iimeko
• Ngokungafaniyo okungaqhelekiyo okuphuhliswayo ngenxa yokuphumelela kwe-chondrogenesis kunye ne-ossification yamaziko angasemva kwe-Atlas

 

 

• Izigulane ezine-Down syndrome zinokukhathazeka ngokunyuka kwesigxina kunye nezinye izinto ezingaqhelekanga
• Umngcipheko wokwanda kwe-subluxation kwi-C1-2

 

 

• Ukuqhuma kweFx (engaqinisekiyo) Iikholomu ze-2 zonakaliswe
• Indlela: ukulayishwa kwe-axial kunye ne-flexion rhoqo emva kokuwa kunye ne-MVAs
• Ummandla we-thoracolumbar ngowona mngcipheko ngenxa yokunyuka kwefom
• I-radiography engundoqo: i-acute compression fracture kunye nokuwa kobude bomzimba, ukubuyiswa komzimba wangasemva kunye nokukhubazeka kwe-kyphotic kwimbono esecaleni.
• Ngombono ongaphambili: ukwanda kwe-interpedicular (ngaphantsi kweloluya oluphuzi)

 

 

• Ukucinga: x-radiografi kufuneka ilandelwe ngu-CT scanning w / o
• I-MRI ukuba i-neurologically ayizinzile ngenxa yentambo okanye i-conus yingozi
• Iingxaki: umonakalo wentambo ngeempawu zecathambo eziphinda zibuyiswe
• Ulawulo: ukungasebenzi ukuba i-neurologically intact kunye ne-50% yomzimba ubuyela umva nge-kyphosis encinci
• Ukusebenza (fusion) ukuba i-50% okanye ngaphezulu umzimba uphinde wenziwe, i-laminar / pedicle Fx, neuro

 

 

I-18-Unyaka Odala Owesifazana Elandela Ingozi yeTampoline

• I-AP kunye nokujonga kamva kwe-L / S
• Qaphela uqhaqho olunzima lweqhinga, umzimba we-vertebral ukwandisa kwizinto ezisemva
• Ukwandisa umgama ojikelezayo phakathi kwe-T11-T12 (ngaphantsi komcibisholo)
• Umgca wokuqhaqhaqhaqhaqhaqha obonakalayo ubonwa ngumbutho we-T12 kwiprojekti ye-AP
• I-scan scan yakwenziwa

 

 

• I-Sagittal yakha kwakhona ii-Thoracic kunye ne-Lumbar CT kwiisitripu zethambo
• Qaphela uqhaqhozo olunzima lweqhinga, umzimba we-T12 ukwandisa kwi-pedicle kunye ne-lamin
• I-Dx: Ukuphulwa kwengozi ye-T12
• IM imaging eyenziwe

 

 

• I-T2 Wl sagittal MRI
• Iziphumo: Ukuqhaqhaqhaqhaqhaqhaqhaqhaqhaqa umzimba we-T12 umzimba uphahla kwizinto eziphambili ezibangela ukuhlwithwa kwe-interspinous and flavum ligaments
• Ukunyanzeliswa kancinci kwintambo yokugqithisa ngaphezu kwe-conus kuphawulwe ngesalathisi esincinci
• I-Dx: Ikhefu lekhefu

 

 

• Ikhefu Fx aka (Seatbelt Fx) - yingozi yokwenza ukuphazamiseka kwesikhumba (engaqinisekanga)
• M / C kwi-thoracic-upper lumbar
• Zonke iikholomu ze-3 ziyahluleka: ikholomu ye-3 idityaniswe nokuphazamiseka, iikholomu ze-1 kunye ne-2 yehluleka ukuxinwa (i-Denis isigaba)
• Izizathu: I-MVA, iwa
• Ukufanekisa: yokuqala x-radiografi kufuneka ilandelwe ngu-CT ukuskena w / o ukuvavanya ukuvavanya iziqhekeza zethambo zokutshintshela / ukunyanzeliswa komdaka. I-MRI inokukunceda ukuvavanya umonakalo wentambo kunye neendandatho zokuqhawula
• Ulawulo: ukungasebenzi ngokungekho kokusebenzayo ukuba i-neuro ingasebenzi
• Ukuchithwa komsebenzi kunye nokuxuba

 

 

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