頸椎骨折-英文【圖好+精】

CervicalSpinefractures…整理課件CervicalAnatomyBiomechanicallySpecializedSupportof“l(fā)arge”CranialmassLargerangeofmotionFlexion/extensionAxialrotationUniqueosteologicalcharacteristics整理課件C1-AtlasNobody2articularpillarsFlatarticularsurfaceVertebralarteryforamen2archesAnteriorPosteriorVertebralarterygroove整理課件Function–TheAtlasTransitionzonebetweenheadandc-spineImportantanatomicalpointsSuperiorarticularprocessesallowflex/extInferiorarticularprocessesareimportantforrotationNotchforvertebralarteryisacommonfracturesite整理課件C2AnatomyDensEmbriologicalC1bodyBasepoorlyvascularizedOsteoporoticFlatC1-2jointsVertebralarteryforamenaInferomedialtosuperolateral整理課件Anatomy–TheAxisImportanttransitionpointforforceswithinthec-spineImportantanatomicalpointsSuperiorandinferiorarticularprocessesare“offset”intheAPdirection-duetodifferentfunctionsateacharticulationParsinterarticularis-duetothistransitionisafrequentfracturesiteOdontoidprocess-the“pivot”forrotation整理課件Anatomy–TheLigamentsAllowforthewideROMofupperC-spinewhilemaintainingstabilityClassifiedaccordingtolocationwithrespecttovertebralcanalInternal:TectorialmembraneCruciateligament–includingtransverseligamentAlarandapicalligamentsExternalAnteriorandposterioratlanto-occipitalmembranesAnteriorandposterioratlanto-axialmembranesArticularcapsulesandligamentumnuchae整理課件AtlantoAxialAnatomyTectorialMembrane整理課件AtlantoAxialAnatomyocciputC1C2TranverseLigamentC1-C2jointAlarLigament整理課件AtlantoAxialAnatomyTransverseLigamentFacetforOccipitalCondyle整理課件AtlantoAxialAnatomyVertebralArtery整理課件APPROACHTOC-SPINEINJURIESFollowingtraumaorcomplaintofneckpainObtainlateralAP,andodontoidviewsThelateralviewisonlyadequateifT1canbevisualizedIfthereisanydoubtoffractureorprevertebralswelling,obtainobliqueviewsandconsiderCTAllpatientswithsign/symptomsofcordinjuryrequireMRI整理課件CervicalViewsAPOdontoidObliques整理課件Swimmer’sView整理課件LATERALVIEW

1.Anteriorvertebralline(anteriormarginofvertebralbodies)2.Posteriorvertebralline(posteriormarginofvertebralbodies)3.Articularpillar(wheresuperiorandinferior

articularprocesses

ofcervicalvertebraehavefusedoneitherorbothsides)4.Spinolaminarline(posteriormarginofspinalcanal)5.Posteriorspinousline(tipsofthespinousprocesses)

整理課件C1-C2Predentalspace(distancebetweenposterioraspectofanteriorarchofC1andanterioraspectofodontoidprocess)shouldbe<3mmInadultandless<5mminchildrenOrlessringsignofC2整理課件C3-C7Anteriorspinal,posteriorspinalandspinolaminarlines:shouldbesmoothlinesDiscSpacesshouldbeapproximatelysame

anteriornarrowing=flexioninjury.Widening=extensioninjuryFacetjointsshouldbeparallelInterspinousdistanceshoulddecreasefromC3toC7TransverseprocessofC7pointsdownwardandT1UPWARDS

INTERVERTEBRALDISCSPACESFACETJOINT整理課件PrevertebralSoftTissueNasopharyngealspace(C1)-10mm(adult)RetropharyngealspaceC2-C4(betweenposteriorpharyngealwallandanteriorborderofvertebrae).

RetrotrachealspaceC5-7(spacebetweenposteriortrachealwallandanteriorinferiorbodyC6)c3-45mmfromvertebralbodyisnormalC4-720mmfromvertebralbodyisnormal5mm22mm10mm整理課件整理課件APViewTheheightofthecervicalvertebralbodiesshouldbeapproximatelyequalTheheightofeachjointspaceshouldberoughlyequalatalllevels.Spinousprocessshouldbeinmidlineandingoodalignment.整理課件OdontoidViewAnadequatefilmshouldincludetheentireodontoidandthelateralbordersofC1-C2.OccipitalcondylesshouldlineupwiththelateralmassesandsuperiorarticularfacetofC1.

ThedistancefromthedenstothelateralmassesofC1shouldbeequalbilaterally.ThetipsoflateralmassofC1shouldlineupwiththelateralmarginsofthesuperiorarticularfacetofC2.TheodontoidshouldhaveuninterruptedcorticalmarginsblendingwiththebodyofC2.整理課件Classificationof

Fracturesofc-spineHYPERFLEXIONINJURIESFlexionteardropfractureHyperflexionStrainWedgeCompressionfractureBilateralfacetLockUnilateralfacetdislocationClay-shoveler’sfractureHyperextentioninjuriesHangmanfractureExtentionteardropfracturelaminarfracturePillarfracturePosteriorarchofc1fractureFRACTUREDUETOAXIALLOADINGJeffersonfractureBurstfractureOTHERINJURIESOdontoidfractureRotationalInjuries

整理課件HyperflexionDistractioncreatestensileforcesinposteriorcolumnCanresultincompressionofbody(anteriorcolumn)MostcommonlyresultsfromMVCandfalls整理課件CompressionResultfromaxialloadingCommonlyfromdiving,football,MVAInjurypatterndependsoninitialheadpositionMaycreateburst,wedgeorcompressionfx’s整理課件HyperextensionImpactionofposteriorarchesandfacetcompressioncausingmanytypesoffx’slaminaspinousprocessespediclesWithdistractiongetdisruptionofALLEvaluatecarefullyforstabilityLOOKFORCENTRALCORDSYNDROME整理課件TypesofInjuries整理課件FlexionTeardropFractureC5-6fractureistheresultofacombinationof

flexion

andcompression,mostcommonlyatC5-6Theteardropfragmentcomesfromtheanteroinferioraspectofthevertebralbody.Thelargerposteriorpartofthevertebralbodyisdisplacedbackwardintothespinalcanal.

BestseenonlateralviewItisancompletelyunstablefractureassociatedwithcompletedisruptionofligamentsandanteriorcordsyndromeandquadriplegia70%moninMOTORVECHICLEACCIDENT整理課件Signs:Prevertebralswellingassociatedwithanteriorlongitudinalligamenttear.Teardropfragmentfromanteriorvertebralbodyavulsionfracture.Posteriorvertebralbodysubluxationintothespinalcanal.

Spinalcordcompressionfromvertebralbodydisplacement.

Fractureofthespinousprocess.整理課件Fractureofthebodyofc5withasmallfragmentanteriorlyFractureofthespinousprocessofC4AcuteangulationatthelevelofC5C6withdisplacementofC5inposteriordirection

整理課件整理課件整理課件整理課件整理課件WedgefractureCompressionfractureresultingfromflexion.FlexioncompressioninjuryBestseenonlateralviewStableCommoninElderlypatientswith

osteoporosis

or

osteogenesisimperfecta整理課件整理課件WedgeshapevertebraAntersuperiorbodyfracture整理課件Hangman’sFractureC-2FxthroughtheparsinterarticularisofC2secondarytohyperextensionBestseenonlateralviewHyperextentioninjuryStablefracture?整理課件整理課件整理課件

Themostcommonscenariowouldbe

frontalmotorvehicle(hittingdashboard)Hangingfalls,divinginjuriescontactsports.Neurologicalinvolvementisrare整理課件整理課件ClassificationofHangman'sfractures

TypeI

(65%)hair-linefractureC2-3discnormalTypeII

(28%)displacedC2disruptedC2-3discligamentousrupturewithinstabilityC3anterosuperiorcompressionfractureTypeIII

(7%)displacedC2C2-3BilateralinterfacetdislocationSevereinstability整理課件TYPE1HANGMANFRACTUREThereisahair-linefractureandthereisnodisplacement.C23NORMAL

整理課件HANGMANFRACTURETYPE3AnteriordislocationoftheC2vertebralbodyBILATRALC2parsinterarticularisfractures.Prevertebralsofttissueswelling整理課件TheCT-imagesconfirmthefracture-linesofthehangman'sfracture.

Theyrunthroughtheparsinterarticularisresultinginatraumaticspondylolysis.

Inthiscasetherewasnoneurologicdeficit,becausethespinalcanaliswidenedatthelevelofthefracture.整理課件整理課件ExtentionteardropfractureAVULSIONFRACTUREofanterioinferiorcontentoftheaxisresultingfromhyperextentionThisinjuryis

monindivingaccidentsItalsomaybeassociatedwiththecentralcordsyndrome.整理課件整理課件整理課件TheCTconfirmsthedisplacedanteroinferiorbonyfragment.

Thisfragmentisatrueavulsion,incontrasttotheflexionteardropfractureinwhichthefragmentisproducedbycompressionoftheanteriorvertebralaspectduetohyperflexion.

整理課件JeffersonFractureC-1BestseenonodontoidviewUnstablefractureFractureduetoAXIALLOADINGfrequentlyassociatedwithdivingintoshallowwater(axialblowtothevertexofthehead)

impactagainsttheroofofavehiclefallfromplaygroundequipmentsFractureiscausedbyacompressivedownwardforce

thatistransmittedevenlythroughtheoccipitalcondylestothesuperiorarticularsurfacesofthelateralmassesofC1.

Thisprocessdisplacesthemasseslaterallyandcausesfracturesoftheanteriorandposteriorarches,alongwithpossibledisruptionofthetransverseligament.整理課件SIGNSONXRAY:DisplacementofthelateralmassesofvertebraeC1beyondthemarginsofthebodyofvertebraC2.<2mmbilateralisalwaysabnormal<1-2mmorunilateraldisplacementcanbeduetoheadrotation整理課件CTisrequiredtodefinetheextentoffracturedetectingfragmentinspinalcord整理課件BURSTFRACTUREC3-7Samemechanismasjeffersonfracturei.eaxialcompressionbutLocatedatc3-7StablefractureTheintervertebraldiscisdrivenintothevertebralbodybelow.PosteriorfragmentsdislocationcommonRequirectforfractureevaluationandbonefragmentinspinalcord整理課件整理課件整理課件OdontoidFractureC2Fractureoftheodontoid(dens)ofC23categories,I-IIIBestseenonopen-mouthodontoidvieworlateralradiographresultfromblunttraumatoheadleadingtocervicalhyperflexionorhyperextensionUnstablefractureOccurinbothelderlyandyoungpatients75%casesarechildren整理課件Classification

TypeI:AvulsionofthetipofthedenswhereitisattachedtoC1.

Thisisararefracture.

Itispotentiallystable.?

TypeII:Throughthebaseofthedens.

Mostcommonfracture.

Alwaysunstableandpoorhealing.

TypeIII:Fracturethroughthebodyoftheaxisandsometimesfacets.

Canbeunstable,buthasabetterprognosisthantypeIIduetobetterhealingofthefracturewhichrunsthroughthemetaphysealbodyofC-2

整理課件Type1odontoidfracture整理課件TypeII整理課件TypeIII整理課件CTIMAGE整理課件DensDENS整理課件TheimagethroughthelateralpartofC2nicelyshows,thatthefracturerunsthroughthebodyofC2,i.e.atypeIIIodontoidfracture.

Theposteriorduraisinanormalposition,buttheanteriorduraisdisplaced(arrow).

整理課件ShowingCentrallocationofspinalcordinjury整理課件ClayShoveler’sFractureObliqueavulsionfractureofaspinousprocessC6-T1C7>C6>T1

BestseenonlateralviewPowerfulHyperflexioninjury(shoveling)StablefractureCommonin

motorvehicleaccidentssuddenmusclecontractiondirectblowstothespine整理課件整理課件Ap