颈椎骨折-英文PPT课件

CervicalSpinefractures,1,PPT学习交流,CervicalAnatomy,BiomechanicallySpecializedSupportof“large”CranialmassLargerangeofmotionFlexion/extensionAxialrotationUniqueosteologicalcharacteristics,2,PPT学习交流,C1-Atlas,Nobody2articularpillarsFlatarticularsurfaceVertebralarteryforamen2archesAnteriorPosteriorVertebralarterygroove,3,PPT学习交流,FunctionTheAtlas,Transitionzonebetweenheadandc-spineImportantanatomicalpointsSuperiorarticularprocessesallowflex/extInferiorarticularprocessesareimportantforrotationNotchforvertebralarteryisacommonfracturesite,4,PPT学习交流,C2Anatomy,DensEmbriologicalC1bodyBasepoorlyvascularizedOsteoporoticFlatC1-2jointsVertebralarteryforamenaInferomedialtosuperolateral,5,PPT学习交流,AnatomyTheAxis,Importanttransitionpointforforceswithinthec-spineImportantanatomicalpointsSuperiorandinferiorarticularprocessesare“offset”intheAPdirection-duetodifferentfunctionsateacharticulationParsinterarticularis-duetothistransitionisafrequentfracturesiteOdontoidprocess-the“pivot”forrotation,6,PPT学习交流,AnatomyTheLigaments,AllowforthewideROMofupperC-spinewhilemaintainingstabilityClassifiedaccordingtolocationwithrespecttovertebralcanalInternal:TectorialmembraneCruciateligamentincludingtransverseligamentAlarandapicalligamentsExternalAnteriorandposterioratlanto-occipitalmembranesAnteriorandposterioratlanto-axialmembranesArticularcapsulesandligamentumnuchae,7,PPT学习交流,AtlantoAxialAnatomy,TectorialMembrane,8,PPT学习交流,AtlantoAxialAnatomy,occiput,C1,C2,TranverseLigament,C1-C2joint,AlarLigament,9,PPT学习交流,AtlantoAxialAnatomy,TransverseLigament,FacetforOccipitalCondyle,10,PPT学习交流,AtlantoAxialAnatomy,VertebralArtery,11,PPT学习交流,APPROACHTOC-SPINEINJURIES,FollowingtraumaorcomplaintofneckpainObtainlateralAP,andodontoidviewsThelateralviewisonlyadequateifT1canbevisualizedIfthereisanydoubtoffractureorprevertebralswelling,obtainobliqueviewsandconsiderCTAllpatientswithsign/symptomsofcordinjuryrequireMRI,12,PPT学习交流,CervicalViews,AP,Odontoid,Obliques,13,PPT学习交流,SwimmersView,14,PPT学习交流,LATERALVIEW,1.Anteriorvertebralline(anteriormarginofvertebralbodies)2.Posteriorvertebralline(posteriormarginofvertebralbodies)3.Articularpillar(wheresuperiorandinferiorarticularprocessesofcervicalvertebraehavefusedoneitherorbothsides)4.Spinolaminarline(posteriormarginofspinalcanal)5.Posteriorspinousline(tipsofthespinousprocesses),15,PPT学习交流,C1-C2,Predentalspace(distancebetweenposterioraspectofanteriorarchofC1andanterioraspectofodontoidprocess)shouldbe3mmInadultandless5mminchildrenOrlessringsignofC2,16,PPT学习交流,C3-C7,Anteriorspinal,posteriorspinalandspinolaminarlines:shouldbesmoothlinesDiscSpacesshouldbeapproximatelysameanteriornarrowing=flexioninjury.Widening=extensioninjuryFacetjointsshouldbeparallelInterspinousdistanceshoulddecreasefromC3toC7TransverseprocessofC7pointsdownwardandT1UPWARDS,INTERVERTEBRALDISCSPACES,FACETJOINT,17,PPT学习交流,PrevertebralSoftTissueNasopharyngealspace(C1)-10mm(adult)RetropharyngealspaceC2-C4(betweenposteriorpharyngealwallandanteriorborderofvertebrae).RetrotrachealspaceC5-7(spacebetweenposteriortrachealwallandanteriorinferiorbodyC6)c3-45mmfromvertebralbodyisnormalC4-720mmfromvertebralbodyisnormal,5mm,22mm,10mm,18,PPT学习交流,19,PPT学习交流,APView,TheheightofthecervicalvertebralbodiesshouldbeapproximatelyequalTheheightofeachjointspaceshouldberoughlyequalatalllevels.Spinousprocessshouldbeinmidlineandingoodalignment.,20,PPT学习交流,OdontoidView,AnadequatefilmshouldincludetheentireodontoidandthelateralbordersofC1-C2.OccipitalcondylesshouldlineupwiththelateralmassesandsuperiorarticularfacetofC1.ThedistancefromthedenstothelateralmassesofC1shouldbeequalbilaterally.ThetipsoflateralmassofC1shouldlineupwiththelateralmarginsofthesuperiorarticularfacetofC2.TheodontoidshouldhaveuninterruptedcorticalmarginsblendingwiththebodyofC2.,21,PPT学习交流,ClassificationofFracturesofc-spine,HYPERFLEXIONINJURIESFlexionteardropfractureHyperflexionStrainWedgeCompressionfractureBilateralfacetLockUnilateralfacetdislocationClay-shovelersfractureHyperextentioninjuriesHangmanfractureExtentionteardropfracturelaminarfracturePillarfracturePosteriorarchofc1fractureFRACTUREDUETOAXIALLOADINGJeffersonfractureBurstfractureOTHERINJURIESOdontoidfractureRotationalInjuries,22,PPT学习交流,Hyperflexion,DistractioncreatestensileforcesinposteriorcolumnCanresultincompressionofbody(anteriorcolumn)MostcommonlyresultsfromMVCandfalls,23,PPT学习交流,Compression,ResultfromaxialloadingCommonlyfromdiving,football,MVAInjurypatterndependsoninitialheadpositionMaycreateburst,wedgeorcompressionfxs,24,PPT学习交流,Hyperextension,ImpactionofposteriorarchesandfacetcompressioncausingmanytypesoffxslaminaspinousprocessespediclesWithdistractiongetdisruptionofALLEvaluatecarefullyforstabilityLOOKFORCENTRALCORDSYNDROME,25,PPT学习交流,TypesofInjuries,26,PPT学习交流,FlexionTeardropFractureC5-6,fractureistheresultofacombinationofflexionandcompression,mostcommonlyatC5-6Theteardropfragmentcomesfromtheanteroinferioraspectofthevertebralbody.Thelargerposteriorpartofthevertebralbodyisdisplacedbackwardintothespinalcanal.BestseenonlateralviewItisancompletelyunstablefractureassociatedwithcompletedisruptionofligamentsandanteriorcordsyndromeandquadriplegia70%moninMOTORVECHICLEACCIDENT,27,PPT学习交流,Signs:Prevertebralswellingassociatedwithanteriorlongitudinalligamenttear.Teardropfragmentfromanteriorvertebralbodyavulsionfracture.Posteriorvertebralbodysubluxationintothespinalcanal.Spinalcordcompressionfromvertebralbodydisplacement.Fractureofthespinousprocess.,28,PPT学习交流,Fractureofthebodyofc5withasmallfragmentanteriorly,FractureofthespinousprocessofC4,AcuteangulationatthelevelofC5C6withdisplacementofC5inposteriordirection,29,PPT学习交流,30,PPT学习交流,31,PPT学习交流,32,PPT学习交流,33,PPT学习交流,Wedgefracture,Compressionfractureresultingfromflexion.FlexioncompressioninjuryBestseenonlateralviewStableCommoninElderlypatientswithosteoporosisorosteogenesisimperfecta,34,PPT学习交流,35,PPT学习交流,Wedgeshapevertebra,Antersuperiorbodyfracture,36,PPT学习交流,HangmansFractureC-2,FxthroughtheparsinterarticularisofC2secondarytohyperextensionBestseenonlateralviewHyperextentioninjuryStablefracture?,37,PPT学习交流,38,PPT学习交流,39,PPT学习交流,Themostcommonscenariowouldbefrontalmotorvehicle(hittingdashboard)Hangingfalls,divinginjuriescontactsports.Neurologicalinvolvementisrare,40,PPT学习交流,41,PPT学习交流,ClassificationofHangmansfracturesTypeI(65%)hair-linefractureC2-3discnormalTypeII(28%)displacedC2disruptedC2-3discligamentousrupturewithinstabilityC3anterosuperiorcompressionfractureTypeIII(7%)displacedC2C2-3BilateralinterfacetdislocationSevereinstability,42,PPT学习交流,TYPE1HANGMANFRACTURE,Thereisahair-linefractureandthereisnodisplacement.C23NORMAL,43,PPT学习交流,HANGMANFRACTURETYPE3,AnteriordislocationoftheC2vertebralbody,BILATRALC2parsinterarticularisfractures.,Prevertebralsofttissueswelling,44,PPT学习交流,TheCT-imagesconfirmthefracture-linesofthehangmansfracture.Theyrunthroughtheparsinterarticularisresultinginatraumaticspondylolysis.Inthiscasetherewasnoneurologicdeficit,becausethespinalcanaliswidenedatthelevelofthefracture.,45,PPT学习交流,46,PPT学习交流,Extentionteardropfracture,AVULSIONFRACTUREofanterioinferiorcontentoftheaxisresultingfromhyperextentionTmonindivingaccidentsItalsomaybeassociatedwiththecentralcordsyndrome.,47,PPT学习交流,48,PPT学习交流,49,PPT学习交流,TheCTconfirmsthedisplacedanteroinferiorbonyfragment.Thisfragmentisatrueavulsion,incontrasttotheflexionteardropfractureinwhichthefragmentisproducedbycompressionoftheanteriorvertebralaspectduetohyperflexion.,50,PPT学习交流,JeffersonFractureC-1,BestseenonodontoidviewUnstablefractureFractureduetoAXIALLOADINGfrequentlyassociatedwithdivingintoshallowwater(axialblowtothevertexofthehead)impactagainsttheroofofavehiclefallfromplaygroundequipments,FractureiscausedbyacompressivedownwardforcethatistransmittedevenlythroughtheoccipitalcondylestothesuperiorarticularsurfacesofthelateralmassesofC1.Thisprocessdisplacesthemasseslaterallyandcausesfracturesoftheanteriorandposteriorarches,alongwithpossibledisruptionofthetransverseligament.,51,PPT学习交流,SIGNSONXRAY:DisplacementofthelateralmassesofvertebraeC1beyondthemarginsofthebodyofvertebraC2.T1BestseenonlateralviewPowerfulHyperflexioninjury(shoveling)StablefractureCommoninmotorvehicleaccidentssuddenmusclecontractiondirectblowstothespine,66,PPT学习交流,67,PPT学习交流,Apviewshowghostsignwith2spinousprocesses?,68,PPT学习交流,Case1,5yogirlHitbycarwhileridingbikeVSAatsceneVitalsrecoveredbyEMS,Roseetal,AmJSurg2003;185(4),69,PPT学习交流,Atlanto-OccipitalDislocation,2.5xmorec