Diskoligamentöz yaralanma (BT dolaylı bulguları)

Özet

Künt servikal travmada disk, faset kapsülü ve posterior ligamentöz kompleksin kopması segmentler arası stabiliteyi bozabilir. BT kemik hizalanmasını ve eklem aralıklarındaki açılmayı gösterir; bağ liflerini ve diskin iç yapısını doğrudan değerlendiremez. Faset ayrışması, disk aralığı açılması veya interspinöz mesafenin artması şüpheyi yükseltir ancak normal BT bağ yaralanmasını tümüyle dışlamaz. Klinik veya nörolojik kuşku sürüyorsa yaralanmanın kapsamını MR ortaya koyabilir.

Faz ve pencere

Kontrastsız tanısal

Sagittal BT'de disk aralığının özellikle arka bölümde açılması, segmental kifoz veya translasyon; aksiyel ve koronal görüntülerde faset eklemi diastazı ile spinöz çıkıntılar arası açıklık aranır. Künt servikal travmada BT taraması rutin olarak intravenöz kontrast olmaksızın uygulanır; vasküler hasar şüphesi durumunda CTA eklenir.

Kemik algoritması tanısal

Servikal travma BT'sinde ince rekonstrüksiyonlar kemik hizalanması, faset eklem uyumu ve köşe avülsiyonlarını gösterir; ligamentöz bütünlük ise bu yapısal bulgulara dayanılarak çıkarılır.

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

BT bulguları

• Disk aralığı açılması — komşu seviyelere göre asimetrik ve özellikle posteriora doğru genişleme distraksiyon yaralanmasını düşündürür.
• Faset diastazı — eklem yüzleri birbirinden ayrılır; eşlik eden subluksasyon veya eklem örtüşmesinin kaybı instabilite lehinedir.
• İnterspinöz genişleme — komşu spinöz çıkıntılar arası mesafenin belirgin artışı posterior gerilim bandı hasarı için dolaylı işarettir.
• Segmental kifoz ve translasyon — tek seviyede normal servikal çizgilerin bozulması disk ve bağ bütünlüğünün kaybıyla birliktelik gösterebilir.
• Küçük avülsiyon — anterior veya posterior köşede bağ yapışma yerinden kopmuş kortikal parça görülebilir.
• Faset konum bozukluğu — üst eklem yüzünün alt faset üzerine oturması veya eklem çizgisinin genişlemesi kapsüler yaralanmayı akla getirir.

Normalde

Normal servikal segmentte vertebra korpuslarının ön ve arka çizgileri akıcıdır; disk aralıkları simetriktir ve faset eklem yüzleri birbirine paralel ve uyumludur. Şüpheli seviyeyi hemen üst ve alt disklerle, iki taraflı faset açıklıklarıyla ve interspinöz mesafeyle kıyaslayın; açılma ya da basamaklaşma tek seviyede odaklanıyor mu diye bakın.

Ayırıcı tanı

Pozisyonel faset asimetrisi değerlendirilirken eklem yüzlerinin sagittal planda paralel, simetrik ve uyumlu olup olmadığı incelenmelidir.

İzole spinöz çıkıntı kırığı

kemik fragmanı belirgindir, ancak disk aralığı ve fasetlerde ek instabilite işareti bulunmayabilir.

Tuzaklar

• İnterspinöz mesafe artışını tek başına kesin bağ yırtığı olarak yorumlamayın; hiperfleksiyon yaralanmasında interlaminar mesafe, interspinöz mesafeden daha güvenilir ve doğrudur.
• Rutin uygulanan servikal travma BT'si önemli kemik yaralanmalarını ayıklamada iyidir ancak yumuşak doku ve ligamentöz bütünlük değerlendirmesinde yetersiz kalabilir.
• Faset eklemi genişliğini tek kesitte değerlendirip parsiyel subluksasyonu kaçırma; eklemi ardışık aksiyel ve parasagittal kesitlerde izle.
• Vertebra korpusunun ön veya arka köşesindeki üçgen avülsiyon parçası, anterior ya da posterior longitudinal bağ yaralanmasının dolaylı bulgusu olabilir.

Kendini dene

1. Künt travma BT'sinde C4–5 posterior disk aralığı açılmış, fasetlerde diastaz var. En olası yaralanma nedir?

   • Distraksiyon tipi diskoligamentöz yaralanma
   • Kronik disk dejenerasyonu
   • İzole transvers çıkıntı kırığı
   • Gelişimsel blok vertebra
   Cevabı göster

   Distraksiyon tipi diskoligamentöz yaralanma. Posterior disk açılması ve faset diastazının aynı seviyede bulunması distraksiyon ve kapsüler yaralanmayı destekler. Dejenerasyonda genellikle daralma ve osteofit, izole kırıkta faset açılması olmaması, blok vertebrada ise kronik füzyon beklenir.

2. Travma sonrası ağrı sürüyor; BT'de hizalanma olağan, ancak bağ hasarı klinik olarak hâlâ olası. Hangi inceleme daha duyarlıdır?

   • Servikal MR
   • Kontrol kontrastlı BT
   • Kemik sintigrafisi
   • Servikal ultrason
   Cevabı göster

   Servikal MR. MR bağ, disk, epidural yumuşak doku ve kord değerlendirmesinde BT'den daha duyarlıdır. Kontrastlı kontrol BT bağ bütünlüğünü göstermede üstün değildir; sintigrafi ve ultrason servikal ligamentleri değerlendirme yöntemi değildir.

Bu konunun yer aldığı turlar

• Omurga travması

İlgili konular

• Travmatik kemik kanal basısı
• Prevertebral yumuşak doku kalınlaşması/hematom

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 8 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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