颈椎骨折-英文课件【图好+精】

1、cervical spine fractures,cervical anatomy,biomechanically specialized support of “large” cranial mass large range of motion flexion/extension axial rotation unique osteological characteristics,c1 - atlas,no body 2 articular pillars flat articular surface vertebral artery foramen 2 arches anterior po

2、sterior vertebral artery groove,function the atlas,transition zone between head and c-spine important anatomical points superior articular processes allow flex/ext inferior articular processes are important for rotation notch for vertebral artery is a common fracture site,c2 anatomy,dens embriologic

3、al c1 body base poorly vascularized osteoporotic flat c1-2 joints vertebral artery foramena inferomedial to superolateral,anatomy the axis,important transition point for forces within the c-spine important anatomical points superior and inferior articular processes are “offset” in the ap direction-

4、due to different functions at each articulation pars interarticularis- due to this transition is a frequent fracture site odontoid process- the “pivot” for rotation,anatomy the ligaments,allow for the wide rom of upper c-spine while maintaining stability classified according to location with respect

5、 to vertebral canal internal: tectorial membrane cruciate ligament including transverse ligament alar and apical ligaments external anterior and posterior atlanto-occipital membranes anterior and posterior atlanto-axial membranes articular capsules and ligamentum nuchae,atlantoaxial anatomy,tectoria

6、l membrane,atlantoaxial anatomy,occiput,c1,c2,tranverse ligament,c1-c2 joint,alar ligament,atlantoaxial anatomy,transverse ligament,facet for occipital condyle,atlantoaxial anatomy,vertebral artery,approach to c-spine injuries,following trauma or complaint of neck pain obtain lateral ap, and odontoi

7、d views the lateral view is only adequate if t1 can be visualized if there is any doubt of fracture or prevertebral swelling , obtain oblique views and consider ct all patients with sign/symptoms of cord injury require mri,cervical views,ap,odontoid,obliques,swimmers view,lateral view,1. anterior ve

8、rtebral line (anterior margin of vertebral bodies) 2. posterior vertebral line (posterior margin of vertebral bodies) 3.articular pillar (where superior and inferiorarticular processesof cervical vertebrae have fused on either or both sides) 4. spinolaminar line (posterior margin of spinal canal) 5.

9、 posterior spinous line (tips of the spinous processes),c1-c2,predental space (distance between posterior aspect of anterior arch of c1 and anterior aspect of odontoid process ) should be 3mm in adult and less 5mm in children or less ring sign of c2,c3-c7,anterior spinal, posterior spinal and spinol

10、aminar lines: should be smooth lines disc spaces should be approximately same anterior narrowing = flexion injury. widening = extension injury facet joints should be parallel interspinous distance should decrease from c3 to c7 transverse process of c7 points downward and t1 upwards,intervertebral di

11、sc spaces,facet joint,prevertebral soft tissue nasopharyngeal space (c1) - 10 mm (adult) retropharyngeal spacec 2-c4 ( between posterior pharyngeal wall and anterior border of vertebrae). retro tracheal space c5-7 (space between posterior tracheal wall and anterior inferior body c6 ) c3-4 5mm from v

12、ertebral body is normal c4-7 20mm from vertebral body is normal,5mm,22mm,10mm,ap view,the height of the cervical vertebral bodies should be approximately equal the height of each joint space should be roughly equal at all levels. spinous process should be in midline and in good alignment.,odontoid v

13、iew,an adequate film should include the entire odontoid and the lateral borders of c1-c2. occipital condyles should line up with the lateral masses and superior articular facet of c1. the distance from the dens to the lateral masses of c1 should be equal bilaterally. the tips of lateral mass of c1 s

14、hould line up with the lateral margins of the superior articular facet of c2. the odontoid should have uninterrupted cortical margins blending with the body of c2.,classification of fractures of c-spine,hyperflexion injuries flexion teardrop fracture hyper flexion strain wedge compression fracture b

15、ilateral facet lock unilateral facet dislocation clay-shovelers fracture hyper extention injuries hangman fracture extention teardrop fracture laminar fracture pillar fracture posterior arch of c1 fracture fracture due to axial loading jefferson fracture burst fracture other injuries odontoid fractu

16、re rotational injuries,hyperflexion,distraction creates tensile forces in posterior column can result in compression of body (anterior column) most commonly results from mvc and falls,compression,result from axial loading commonly from diving, football, mva injury pattern depends on initial head pos

17、ition may create burst, wedge or compression fxs,hyperextension,impaction of posterior arches and facet compression causing many types of fxs lamina spinous processes pedicles with distraction get disruption of all evaluate carefully for stability look for central cord syndrome,types of injuries,fle

18、xion teardrop fracture c5-6,fracture is the result of a combination offlexionand compression ,most commonly at c5-6 the teardrop fragment comes from the anteroinferior aspect of the vertebral body. the larger posterior part of the vertebral body is displaced backward into the spinal canal. best seen

19、 on lateral view it is an completely unstable fracture associated with complete disruption of ligaments and anterior cord syndrome and quadriplegia 70% of patients have neurologic deficit. common in motor vechicle accident,signs: prevertebral swelling associated with anterior longitudinal ligament t

20、ear. teardrop fragment from anterior vertebral body avulsion fracture. posterior vertebral body subluxation into the spinal canal. spinal cord compression from vertebral body displacement. fracture of the spinous process.,fracture of the body of c5 with a small fragment anteriorly,fracture of the sp

21、inous process of c4,acute angulation at the level of c5c6 with displacement of c5 in posterior direction,wedge fracture,compression fracture resulting from flexion. flexion compression injury best seen on lateral view stable common in elderly patients withosteoporosisorosteogenesis imperfecta,wedge

22、shape vertebra,antersuperior body fracture,hangmans fracture c-2,fx through the pars interarticularis of c2 secondary to hyperextension best seen on lateral view hyperextention injury stable fracture ?,the most common scenario would be frontal motor vehicle(hitting dash board) hanging falls, diving

23、injuries contact sports. neurological involvement is rare,classification of hangman s fractures type i(65%) hair-line fracture c2-3 disc normal type ii(28%) displaced c2 disrupted c2-3 disc ligamentous rupture with instability c3 anterosuperior compression fracture type iii(7%) displaced c2 c2-3 bil

24、ateral interfacet dislocation severe instability,type 1 hangman fracture,there is a hair-line fracture and there is no displacement. c23 normal,hangman fracture type 3,anterior dislocation of the c2 vertebral body,bilatral c2 pars interarticularis fractures.,prevertebral soft tissue swelling,the ct-

25、images confirm the fracture-lines of the hangmans fracture.they run through the pars interarticularis resulting in a traumatic spondylolysis.in this case there was no neurologic deficit, because the spinal canal is widened at the level of the fracture.,extention tear drop fracture,avulsion fracture

26、of anterio inferior content of the axis resulting from hyperextention this injury is stable in flexion but highly unstable in extension. common in diving accidents it also may be associated with the central cord syndrome .,the ct confirms the displaced anteroinferior bony fragment.this fragment is a

27、 true avulsion, in contrast to the flexion teardrop fracture in which the fragment is produced by compression of the anterior vertebral aspect due to hyperflexion.,jefferson fracture c-1,best seen on odontoid view unstable fracture fracture due to axial loading frequently associated with diving into

28、 shallow water(axial blow to the vertex of the head ) impact against the roof of a vehicle fall from playground equipments,fracture is caused by a compressive downward force that is transmitted evenly through the occipital condyles to the superior articular surfaces of the lateral masses of c1.this

29、process displaces the masses laterally and causes fractures of the anterior and posterior arches, along with possible disruption of the transverse ligament.,signs on xray: displacement of the lateral masses of vertebrae c1 beyond the margins of the body of vertebra c2. 2mm bilateral is always abnorm

30、al 1-2 mm or unilateral displacement can be due to head rotation,ct is required to define the extent of fracture detecting fragment in spinal cord,burst fracture c3-7,same mechanism as jefferson fracture i.e axial compression but located at c3-7 stable fracture the intervertebral disc is driven into

31、 the vertebral body below. posterior fragments dislocation common require ct for fracture evaluation and bone fragment in spinal cord,odontoid fracture c2,fracture of the odontoid (dens) of c2 3 categories, i-iii best seen on open-mouth odontoid view or lateral radiograph result from blunt trauma to

32、 head leading to cervical hyperflexion or hyperextension unstable fracture occur in both elderly and young patients 75% cases are children,classificationtype i: avulsion of the tip of the dens where it is attached to c1.this is a rare fracture.it is potentially stable.?type ii: through the base of t

33、he dens.most common fracture.always unstable and poor healing.type iii: fracture through the body of the axis and sometimes facets.can be unstable, but has a better prognosis than type ii due to better healing of the fracture which runs through the metaphyseal body of c-2,type 1 odontoid fracture,ty

34、pe ii,type iii,ct image,dens,dens,the image through the lateral part of c2 nicely shows, that the fracture runs through the body of c2, i.e. a type iii odontoid fracture.the posterior dura is in a normal position, but the anterior dura is displaced (arrow).,showing central location of spinal cord injury,clay shovelers fracture,oblique avulsion fracture of a spinous process c6-t1 c7c6t1 best seen on lateral view powerful hyperflexion injury(shoveling) stable fracture common in motor vehicle accidents sudden muscle contraction direct blows to the spine,ap view show gh