颈椎骨折-英文课件PPT课件.ppt

CervicalSpinefractures CervicalAnatomy BiomechanicallySpecializedSupportof large CranialmassLargerangeofmotionFlexion extensionAxialrotationUniqueosteologicalcharacteristics C1 Atlas Nobody2articularpillarsFlatarticularsurfaceVertebralarteryforamen2archesAnteriorPosteriorVertebralarterygroove Function TheAtlas Transitionzonebetweenheadandc spineImportantanatomicalpointsSuperiorarticularprocessesallowflex extInferiorarticularprocessesareimportantforrotationNotchforvertebralarteryisacommonfracturesite C2Anatomy DensEmbriologicalC1bodyBasepoorlyvascularizedOsteoporoticFlatC1 2jointsVertebralarteryforamenaInferomedialtosuperolateral Anatomy TheAxis Importanttransitionpointforforceswithinthec spineImportantanatomicalpointsSuperiorandinferiorarticularprocessesare offset intheAPdirection duetodifferentfunctionsateacharticulationParsinterarticularis duetothistransitionisafrequentfracturesiteOdontoidprocess the pivot forrotation Anatomy TheLigaments AllowforthewideROMofupperC spinewhilemaintainingstabilityClassifiedaccordingtolocationwithrespecttovertebralcanalInternal TectorialmembraneCruciateligament includingtransverseligamentAlarandapicalligamentsExternalAnteriorandposterioratlanto 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 Swimmer sView LATERALVIEW 1 Anteriorvertebralline anteriormarginofvertebralbodies 2 Posteriorvertebralline posteriormarginofvertebralbodies 3 Articularpillar wheresuperiorandinferiorarticularprocessesofcervicalvertebraehavefusedoneitherorbothsides 4 Spinolaminarline posteriormarginofspinalcanal 5 Posteriorspinousline tipsofthespinousprocesses C1 C2 Predentalspace distancebetweenposterioraspectofanteriorarchofC1andanterioraspectofodontoidprocess shouldbe 3mmInadultandless 5mminchildrenOrlessringsignofC2 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 shoveler sfractureHyperextentioninjuriesHangmanfractureExtentionteardropfracturelaminarfracturePillarfracturePosteriorarchofc1fractureFRACTUREDUETOAXIALLOADINGJeffersonfractureBurstfractureOTHERINJURIESOdontoidfractureRotationalInjuries Hyperflexion DistractioncreatestensileforcesinposteriorcolumnCanresultincompressionofbody anteriorcolumn MostcommonlyresultsfromMVCandfalls Compression ResultfromaxialloadingCommonlyfromdiving football MVAInjurypatterndependsoninitialheadpositionMaycreateburst wedgeorcompressionfx s Hyperextension Impactionofposteriorarchesandfacetcompressioncausingmanytypesoffx slaminaspinousprocessespediclesWithdistractiongetdisruptionofALLEvaluatecarefullyforstabilityLOOKFORCENTRALCORDSYNDROME TypesofInjuries FlexionTeardropFractureC5 6 fractureistheresultofacombinationofflexionandcompression mostcommonlyatC5 6Theteardropfragmentcomesfromtheanteroinferioraspectofthevertebralbody Thelargerposteriorpartofthevertebralbodyisdisplacedbackwardintothespinalcanal BestseenonlateralviewItisancompletelyunstablefractureassociatedwithcompletedisruptionofligamentsandanteriorcordsyndromeandquadriplegia70 moninMOTORVECHICLEACCIDENT Signs Prevertebralswellingassociatedwithanteriorlongitudinalligamenttear Teardropfragmentfromanteriorvertebralbodyavulsionfracture Posteriorvertebralbodysubluxationintothespinalcanal Spinalcordcompressionfromvertebralbodydisplacement Fractureofthespinousprocess Fractureofthebodyofc5withasmallfragmentanteriorly FractureofthespinousprocessofC4 AcuteangulationatthelevelofC5C6withdisplacementofC5inposteriordirection Wedgefracture Compressionfractureresultingfromflexion FlexioncompressioninjuryBestseenonlateralviewStableCommoninElderlypatientswithosteoporosisorosteogenesisimperfecta Wedgeshapevertebra Antersuperiorbodyfracture Hangman sFractureC 2 FxthroughtheparsinterarticularisofC2secondarytohyperextensionBestseenonlateralviewHyperextentioninjuryStablefracture Themostcommonscenariowouldbefrontalmotorvehicle hittingdashboard Hangingfalls divinginjuriescontactsports Neurologicalinvolvementisrare ClassificationofHangman sfracturesTypeI 65 hair linefractureC2 3discnormalTypeII 28 displacedC2disruptedC2 3discligamentousrupturewithinstabilityC3anterosuperiorcompressionfractureTypeIII 7 displacedC2C2 3BilateralinterfacetdislocationSevereinstability TYPE1HANGMANFRACTURE Thereisahair linefractureandthereisnodisplacement C23NORMAL HANGMANFRACTURETYPE3 AnteriordislocationoftheC2vertebralbody BILATRALC2parsinterarticularisfractures Prevertebralsofttissueswelling TheCT imagesconfirmthefracture linesofthehangman sfracture Theyrunthroughtheparsinterarticularisresultinginatraumaticspondylolysis Inthiscasetherewasnoneurologicdeficit becausethespinalcanaliswidenedatthelevelofthefracture Extentionteardropfracture AVULSIONFRACTUREofanterioinferiorcontentoftheaxisresultingfromhyperextentionTmonindivingaccidentsItalsomaybeassociatedwiththecentralcordsyndrome TheCTconfirmsthedisplacedanteroinferiorbonyfragment Thisfragmentisatrueavulsion incontrasttotheflexionteardropfractureinwhichthefragmentisproducedbycompressionoftheanteriorvertebralaspectduetohyperflexion JeffersonFractureC 1 BestseenonodontoidviewUnstablefractureFractureduetoAXIALLOADINGfrequentlyassociatedwithdivingintoshallowwater axialblowtothevertexofthehead impactagainsttheroofofavehiclefallfromplaygroundequipments FractureiscausedbyacompressivedownwardforcethatistransmittedevenlythroughtheoccipitalcondylestothesuperiorarticularsurfacesofthelateralmassesofC1 Thisprocessdisplacesthemasseslaterallyandcausesfracturesoftheanteriorandposteriorarches alongwithpossibledisruptionofthetransverseligament SIGNSONXRAY DisplacementofthelateralmassesofvertebraeC1beyondthemarginsofthebodyofvertebraC2 2mmbilateralisalwaysabnormal 1 2mmorunilateraldisplacementcanbeduetoheadrotation CTisrequiredtodefinetheextentoffracturedetectingfragmentinspinalcord BURSTFRACTUREC3 7 Samemechanismasjeffersonfracturei eaxialcompressionbutLocatedatc3 7StablefractureTheintervertebraldiscisdrivenintothevertebralbodybelow PosteriorfragmentsdislocationcommonRequirectforfractureevaluationandbonefragmentinspinalcord OdontoidFractureC2 Fractureoftheodontoid dens ofC23categories I IIIBestseenonopen mouthodontoidvieworlateralradiographresultfromblunttraumatoheadleadingtocervicalhyperflexionorhyperextensionUnstablefractureOccurinbothelderlyandyoungpatients75 casesarechildren ClassificationTypeI AvulsionofthetipofthedenswhereitisattachedtoC1 Thisisararefracture Itispotentiallystable TypeII Throughthebaseofthedens Mostcommonfracture Alwaysunstableandpoorhealing TypeIII Fracturethroughthebodyoftheaxisandsometimesfacets Canbeunstable buthasabetterprognosisthantypeIIduetobetterhealingofthefracturewhichrunsthroughthemetaphysealbodyofC 2 Type1odontoidfracture TypeII TypeIII CTIMAGE Dens DENS TheimagethroughthelateralpartofC2nicelyshows thatthefracturerunsthroughthebodyofC2 i e atypeIIIodontoidfracture Theposteriorduraisinanormalposition buttheanteriorduraisdisplaced arrow ShowingCentrallocationofspinalcordinjury ClayShoveler sFracture ObliqueavulsionfractureofaspinousprocessC6 T1C7 C6 T1BestseenonlateralviewPowerfulHyperflexioninjury shoveling StablefractureCommoninmotorvehicleaccidentssuddenmusclecontractiondirectblowstothespine Apviewshowghostsignwith2s