Servikal translasyonel kırık-çıkık

Özet

Yüksek enerjili fleksiyon, rotasyon veya kesme kuvvetleri C3–C7 hareket segmentinde bir vertebrayı komşusuna göre kaydırıp kemik ve disk-bağ yapılarında kopmaya yol açabilir. MDCT, travmada vertebral hizalanmayı ve translasyonu, faset eklem uyumunu, kırıkları ve retropulsiyonu hızlıca değerlendirmeyi sağlar. Görüntüdeki yer değiştirme yalnız tek bir korpus çizgisi olarak ele alınmamalı; iki komşu vertebra ile fasetlerin üç boyutlu ilişkisi tanımlanmalıdır. Yaralanmanın translasyon bileşenini veya kanala taşan parçayı atlamak instabilitenin ve olası sinir dokusu basısının eksik raporlanması demektir.

Faz ve pencere

Kontrastsız tanısal

Sagittal BT rekonstrüksiyonlarında ön ve arka korteks çizgilerini izleyerek hizalanmayı ve anteroposterior translasyonu değerlendirin; kırıkları tüm düzlemlerde inceleyin. Kontrast fazı kemik yer değiştirmesinin tanısında gerekli değildir.

Kemik algoritması tanısal

İnce kesit kemik algoritması korpus arka duvarı, pedikül, lamina ve faset kırıkları ile retropulsiyonu gösterir; ancak diskoligamentöz kompleks ve omurilik hasarı gibi yumuşak doku bulguları için BT yetersiz kalabilir.

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

BT bulguları

• Korpus translasyonu — üst ve alt vertebra arka korteksleri aynı çizgide değildir; kaymanın anterior, posterior veya lateral yönü belirtilir.
• Segmental rotasyon — rotasyon deformitesini değerlendirmek için aksiyel kesitlerde unsinat çıkıntıların, koronal kesitlerde spinöz çıkıntıların hizalanmasını inceleyin.
• Faset eklem uyumsuzluğu — bir veya iki tarafta artiküler yüzler ayrılmış, atlamış ya da kilitli görünür.
• Disk aralığı distraksiyonu — hareket segmentinde açılma, yumuşak doku yoğunluğu veya disk düzeyinde kemik ayrışması izlenebilir.
• Korpus arka duvar kırığı — posterior korteks kesintisiyle birlikte fragman spinal kanala doğru yer değiştirebilir.
• Posterior eleman kırığı — faset, pedikül, lamina veya spinöz çıkıntı kırığı translasyon düzeyinde hizalanma kaybına eşlik edebilir.
• Kanal kemik sınırı daralması — retropulse korpus fragmanı veya yer değiştirmiş posterior eleman kanal içi kemik alanını azaltır.

Ölçütler ve sınıflamalar

AO Spine subaksiyel Tip C

Bir vertebra gövdesi komşu vertebraya göre herhangi bir yönde yer değiştirir veya translasyon gösterir; yaralanma hareket segmenti düzeyinde adlandırılır.

SLIC morfoloji bileşeni

SLIC morfolojisinde rotasyon ve/veya translasyon ayrı puanlanan bir kategoridir; sınıflama diskoligamentöz kompleks ve nörolojik durumu da içerir.

Normalde

Normal segmentte vertebra gövdelerinin ön ve arka korteksleri sagittal planda yumuşak devamlı çizgiler oluşturur; faset eklemleri sağ ve solda karşılıklı oturur. Yaralı seviyede aynı çizgilerin basamak yaptığı yönü, fasetlerde örtüşme kaybını ve arka duvar fragmanının kanal konturuna uzanıp uzanmadığını komşu seviyelerle kıyaslayın.

Ayırıcı tanı

Akut burst kırığı

posterior korpus duvarı fragmanları ve gövde çökmesi ön plandadır; komşu vertebraya göre gerçek translasyon yoksa Tip C diye adlandırılmaz.

Rotasyonel tek taraflı faset çıkığı

aksiyel rotasyon ve bir fasette atlama belirgindir; diğer faset eklemi korunabilir, iki taraflı simetrik atlama beklenmez.

Tuzaklar

• Sagittal düzlemdeki görünen basamaklar artefakt kaynaklı olabilir; doğru translasyon tanısı için koronal ve aksiye yeniden yapılandırmalarda vertebral hizalanma ve kesit açısı doğrulanmalıdır.
• Korpus hizalanmasına odaklanıp fasetleri atlamayın; aksiyel ve parasagittal kesitlerde her iki eklemin oturuşu yaralanmanın rotasyon ve çıkık bileşenini açığa çıkarır.
• Kemik kanalı dar görünmüyor diye yaralanmayı stabil kabul etmeyin; diskoligamentöz hasar BT'de eksik görülebilir ve omurilik BT'de doğrudan değerlendirilemez.

Kendini dene

1. C5 gövdesi C6'ya göre öne kaymış, arka korteksler basamak yapıyor ve bir faset eklemi ayrışmış. Hangi morfoloji tanımı uygundur?

   • AO Tip C translasyon
   • A1 kompresyon kırığı
   • B3 anterior band hasarı
   • İzole lamina kırığı
   Cevabı göster

   AO Tip C translasyon. Komşu vertebralar arasında gerçek yer değiştirme AO Tip C translasyon morfolojisidir. B3 anterior tension-band ayrılmasını, A1 kompresyonu, izole lamina kırığı ise tek posterior kemik elemanı hasarını tanımlar.

2. Travmalı hastada C6 arka duvarında kanala uzanan kemik parçası ve gövde yüksekliğinde çökme var, korpus hizası korunmuş. En iyi morfoloji hangisi?

   • Burst kırığı
   • Translasyonel çıkık
   • Tek taraflı faset kilitlenmesi
   • Konjenital blok vertebra
   Cevabı göster

   Burst kırığı. Arka duvar retropulsiyonu ve gövde çökmesi, komşu vertebralar arası kayma yoksa burst örüntüsünü destekler. Translasyonel çıkıkta korpuslar arası yer değiştirme; faset kilitlenmesinde eklem atlaması; blok vertebrada ise kronik füzyon beklenir.

İlgili konular

• Tek taraflı faset kilitlenmesi/çıkığı
• Çift taraflı faset kilitlenmesi/çıkığı
• Servikal faset kırığı

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 5 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.