Denis zon 3 ve transvers sakral kırık

Özet

Denis zon 3, kırık hattının sakral foraminaların medialinde kanal tarafında ilerlediği yerleşimi tanımlar. Klasik zon 3 örüntüsü çoğunlukla transvers bileşenli U/H tipi kırık ve spinopelvik ayrışmadır; ancak medialdeki her kırık bu ayrışmayı oluşturmaz. İnce kesitli BT’de dikey ve transvers kolları, korpus basamaklanmasını ve kanaldaki retropulse fragmanları birlikte izleyin; multiplanar değerlendirme olmadan instabiliteyi eksik tanımlama riski vardır.

Faz ve pencere

Kontrastsız tanısal

Kontrastsız BT kırık geometrisi, deplasman ve kanal çapındaki kemik kaynaklı daralmayı gösterir; aktif kanama veya damar yaralanmasının değerlendirilmesi için kontrastlı görüntüleme gereklidir. İnce kesit kemik rekonstrüksiyonlarında sakral foraminaların medialindeki kortikal kesinti, korpus boyunca yatay/transvers hat, iki dikey sakral kanat kolu ve kanal içine uzanan retropulse fragman seçilir.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

• Sakral foraminaların medialinde, sakral kanala giren kortikal kırık hattı
• Sakral korpusu yatay kesen transvers bileşen; düzeyi S1-S5 boyunca değişebilir
• İki dikey transforaminal veya foramina medialindeki kolu transvers hatla birleştiren U/H örüntüsü
• Lumbosakral bileşkenin alt sakrum ve pelvisle kemik sürekliliğinin kesilmesi
• Korpusun öne kayması, açılanması veya kifotik basamaklanması
• Kanal içine retropulse kemik fragmanı ve sakral kanal konturunda daralma
• Eşlik eden sakral foraminal kırıklar, SI eklem hasarı ve ön halka kırıkları

Ölçütler ve sınıflamalar

Denis sakral zonları

Denis zon 1 foraminaların lateralinde, zon 2 foraminaların içinden, zon 3 medialinde/kanal tarafındadır. Denis zon 3 kırıkları sakral kanalı tutar; yüksek enerjili travmalarda transvers bileşenli U veya H tipi kırıklar sık görülen spinopelvik ayrışma örüntüleridir. Hat yönü, kanal ilişkisi ve spinopelvik sürekliliği ayrı tarif edin.

Roy-Camille transvers sakral kırık sınıflaması

Roy–Camille sınıflaması transvers sakral kırıklarda üst fragmanın öne veya arkaya kaymasını tanımlar; tip III tam antevertebral displasman ile karakterizedir.

AO Spine sakral yaralanma sınıflaması

AO Spine sınıflamasında B1, sakral kanalı tutan Denis zon 3 tipi yaralanmayı; C0 deplase olmayan U tipi kırığı, C3 ise deplase U tipi kırığı tanımlar. Zon 3 ifadesi tek başına C tipi veya spinopelvik ayrışma anlamına gelmez.

Normalde

Normal sakrumda korpus arka duvarı ve sakral kanalın kemik konturu kesintisizdir; foraminalar iki tarafta düzenli aralıklarla izlenir.

Ayırıcı tanı

Sakral ala yetmezlik kırığı

foraminaların lateralinde dikey alar sklerotik hatlar ve eşlik eden kemik yoğunluğu kaybı ön plandadır.

Denis zon 2 kırığında hat sakral foraminalar bölgesindedir; sakral kanalı tutan zon 3 örüntüsünden bu yönüyle ayrılır.

Sakrokoksigeal transvers kırık

daha kaudalde koksiks veya sakrokoksigeal bileşkeyi tutar, S1-S3 korpus ayrışması yaratmaz.

Sakral metastatik lezyon

kortikal yıkımla birlikte litik/sklerotik odak ve yumuşak doku bileşeni görülebilir; travmatik keskin hat görünümü tipik değildir.

Tuzaklar

• Tek taraflı transforaminal kırığa eşlik eden karşı SI eklem ayrışmasını aramamak, tamamlanmamış gibi görünen T veya lambda örüntüsünde instabiliteyi eksik sınıflandırabilir.
• H tipi sakral kırıkta üç boyutlu BT rekonstrüksiyonunda bilateral dikey ve transvers bileşenleri birlikte değerlendir.
• Kanal içi kemik fragmanı ile yalnız yumuşak doku hematomunu ayır; kemik algoritmasında fragmanın kortikal devamlılığını izle.

Kendini dene

1. Yüksek enerjili travma sonrası sagittal BT'de S2'nin üst fragmanı kifotik ve arkaya ötelenmiş. Hangi örüntü en olasıdır?

   • Roy-Camille tip II
   • Denis zon 1
   • Sakral ala yetmezliği
   • Sakrokoksigeal ayrılma
   Cevabı göster

   Roy-Camille tip II. Kifozla birlikte üst sakral fragmanın retrolistezisi Roy-Camille tip II ile uyumludur. Denis zon 1 alar bölgenin yerini belirtir; yetmezlik kırığı düşük enerjili alar paterndir; sakrokoksigeal ayrılma bu S2 deplasmanını açıklamaz.

2. BT'de kırık hattı sakral foraminaları tutuyor ve sakral kanala uzanmıyor. Bu kırık hangi Denis zonundadır?

   • Zon 1
   • Zon 2
   • Zon 3
   • AO Spine C3
   Cevabı göster

   Zon 2. Foraminalar bölgesindeki ve sakral kanalı tutmayan kırık Denis zon 2 olarak sınıflanır. Zon 1 sakral kanat bölgesindedir; zon 3 sakral kanalı tutar. AO Spine C3 ise deplase U tipi sakral kırığı tanımlar.

İlgili konular

• Pelvis kırılganlık kırıkları

Kaynaklar

Bu sayfadaki 44 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 12 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.