颈椎骨折-英文完整【图好+精】PPT课件

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