Kombine mekanizmalı pelvik yaralanma BT bulguları

Özet

Yüksek enerjili pelvik halka yaralanmalarında aynı olguda birden fazla kuvvet vektörü ve farklı yönlü deformasyonlar bulunabilir. Young–Burgess sınıflaması APC, LC, vertikal shear ve kombine mekanizma (CM) kategorilerini içerir. BT, ön ve arka halka kırıklarını ve yer değiştirme yönlerini multiplanar rekonstrüksiyonlarda göstererek örüntünün haritalanmasına katkı sağlar. Young–Burgess sınıflaması kombine mekanizma (CM) kategorisini içerir; bu kategori LC-I–III alt tiplerinden ayrı olarak adlandırılır. Arka halka yaralanması, aktif kanama ve eşlik eden organ yaralanmaları ayrı değerlendirilmezse BT’de yaralanma kapsamı eksik kalabilir.

Okuma sırası

Ön halka ve pubik ramuslar. Pelvik BT’de halka kırıklarını sistematik biçimde değerlendirin; BT bu kırıkları hızlı ve doğru biçimde saptayabilir.
İpsilateral sakral ala, posterior iliak kanat ve SI eklemi. Ramus bulgusuna eşlik edebilecek posterior halka yaralanmasını BT’de dikkatle arayın; pelvis halka biçimli olduğundan izole ramus kırıkları posterior halka bozulması açısından değerlendirilmelidir.
İpsilateral posterior halka ve karşı SI eklemi. Posterior halka yaralanmasının derecesini değerlendirerek LC alt tipini belirleyin; LC kırıkları I–III olarak bu ölçüte göre sınıflandırılır.
Hemipelvis yüksekliği ve pelvik yumuşak dokular. Kemik halkayı okuduktan sonra kontrast ekstravazasyonu ve diğer sistemlerdeki yaralanmalar için tüm taramayı yeniden gözden geçirin.

Faz ve pencere

Kontrastsız tanısal: Pelvik BT, halka kırıklarını hızlı ve doğru biçimde gösterebilir.
Arteriyel tanısal: Kontrastlı BT’de aktif ekstravazasyon veya psödoanevrizma gibi damar yaralanması bulguları aranır; Young–Burgess sınıflaması mekanizma ve kırık stabilitesini birlikte ele alır.
Portal venöz tanısal: Pelvik travma BT’sinde halka kırıkları, aktif kanama ve diğer vücut sistemlerindeki yaralanmalar değerlendirilebilir.
Kemik algoritması tanısal: Pelvik BT, halka kırıklarını ve eşlik eden yaralanmaları göstermeye katkı sağlar.

Önerilen pencereler G genişlik, M merkez; değerler Hounsfield birimi (HU)

KemikG 1800 / M +400
Yumuşak dokuG 400 / M +40
AnjiyoG 600 / M +150

BT bulguları

Birden fazla kuvvet yönü — Young–Burgess sınıflaması APC, LC, vertikal shear ve kombine mekanizma (CM) kategorilerini içerir.
LC bileşeni — pubik ramus kırıklarıyla aynı tarafta sakral ala impaksiyonu veya posterior iliak crescent (hilal) kırığı LC paternini destekler.
APC yaralanmalarında pubik diastazla birlikte SI eklem genişlemesi bulunabilir.
Düz grafide izole pubik ramus kırığı varsa posterior pelvik halka BT ile dikkatle değerlendirilmelidir.
Vertikal shear yaralanmasında kraniyal hemipelvis göçü ve posterior halka yaralanması birlikte görülebilir.
Ön halka örüntüsünde pubik ramus kırıkları tanımlanır; düz grafide izole görüldüklerinde posterior halka BT ile dikkatle değerlendirilir.
Pelvik halka kırıklarında arteriyel ve venöz kanamalar görülebilir; hematomun yeri anatomik konumuyla tarif edilir.
Pelvik travma BT’sinde aktif kanama ve diğer sistem yaralanmaları değerlendirilir; kontrast ekstravazasyonu veya psödoanevrizma damar yaralanması bulguları arasındadır.
Young–Burgess sınıflamasında LC-III, LC alt tiplerinden biridir; LC kırıkları posterior halka bozulmasının derecesine göre I–III olarak sınıflandırılır.

Ölçütler ve sınıflamalar

Young–Burgess pelvis kırığı sınıflaması: kombine mekanizma (CM): Young–Burgess sınıflaması APC, LC, vertikal shear ve kombine mekanizma (CM) örüntülerini tanımlar. Young–Burgess sınıflamasında LC kırıkları I–III alt tiplerine ayrılır; bu alt tipler posterior halka hasarının derecesine göre belirlenir. LC-III, LC alt tiplerinden biridir; kombine mekanizma (CM) ise Young–Burgess sınıflamasında ayrı bir kategoridir.
WSES pelvik travma sınıflaması: WSES pelvik travma sınıflaması Young–Burgess mekanik örüntülerini hemodinamik durumla birlikte ele alır. WSES pelvik travma yaklaşımında sınıflama ve yönetim, hemodinamik durum ile pelvik halka işlevindeki anatomik bozulmayı ve eşlik eden yaralanmaları birlikte dikkate alır.

Normalde

Pelvik BT’de pelvik halka kırıkları değerlendirilebilir.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s1256; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

LC-III: LC kırıklarının posterior halka hasarı derecesine göre tanımlanan alt tiplerinden biridir.
Young–Burgess sınıflamasında vertikal shear ayrı bir mekanizma kategorisidir; vertikal instabilite içeren karmaşık pelvik yaralanmalarda kraniyal hemipelvis göçü ve posterior halka yaralanması birlikte görülebilir.
APC-III, anteroposterior kompresyon tip III pelvik halka yaralanmasıdır.
LC-II: LC kırıkları, posterior halka hasarının derecesine göre I–III alt tiplerine ayrılır.
Çok odaklı ama tek vektörlü halka kırığı: Young–Burgess CM tanımı birden fazla temel kuvvet vektörünün özelliklerini gerektirir; yalnız kırık sayısı CM demek için yeterli değildir.

Tuzaklar

Pelvik travma BT’si halka kırıklarını, aktif kanamayı ve diğer vücut sistemlerindeki yaralanmaları saptamaya katkı sağlar.
LC kırıkları posterior halka bozulmasının derecesine göre I–III olarak alt sınıflara ayrılır; kombine mekanizma Young–Burgess sınıflamasında ayrı bir kategoridir.
Young–Burgess sınıflaması mekanizma temelli olduğundan, pelvik halka yaralanmasını yalnız kırık sayısına göre sınıflandırmayın.
Travma BT’sinde standart portal venöz faz kullanılabilir veya split-bolus protokolü arteriyel ve venöz faz değerlendirmesini tek edinimde birleştirebilir.

Kendini dene

Young–Burgess sınıflamasında lateral kompresyon (LC) kırıkları I–III alt tiplerine hangi ölçüte göre ayrılır?
Cevabı göster
Posterior halka yaralanmasının derecesi. LC kırıkları I–III alt tiplerine posterior halka yaralanmasının derecesine göre ayrılır.
Düz grafide izole pubik ramus kırığı görüldüğünde posterior pelvik halka için hangi inceleme önerilir?
Cevabı göster
BT. Pelvis halka biçimli olduğundan, düz grafide izole pubik ramus kırığı olağandışıdır; posterior pelvik halka BT ile dikkatle değerlendirilmelidir.

İlgili konular

Kaynaklar

Bu sayfadaki 44 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 29 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.