Torakolomber burst kırığı

Özet

Burst kırığı, genellikle aksiyel yükün korpusu parçalayarak son plak ve posterior duvarı birlikte tutmasıyla oluşur. Travma BT'si kırık parçalarının dağılımını, retropulsiyonu, kanal daralmasını ve posterior eleman yaralanmasını kemik ayrıntısıyla gösterir. Nörolojik hasar riski yalnız kanal görünümünden çıkarılamaz; BT morfolojisi nörolojik muayene ve gerekirse MR ile tamamlanır. Burst kırığında posterior duvarın kanala doğru çıkıntısı ve spinal kanal daralması, kama kırıklarında bulunmayan ayırt edici bulgulardır; bu yapıların değerlendirilmemesi kırığın tipini yanlış sınıflandırmaya yol açabilir.

Faz ve pencere

Kontrastsız tanısal

Kontrastsız BT kemik algoritmasında posterior duvar kırığı, kanala retropulse fragman, interpediküler genişleme ve spinal kanal darlığı gibi burst kırığı bulguları değerlendirilebilir.

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

BT bulguları

• Posterior korpus duvarında kortikal kırık ve kanala doğru yer değiştirmiş kemik parçası burst yaralanmasının ayırt edici morfolojisidir.
• AO Spine sistemine göre A4 tipi kırıklar, posterior duvar kırığı ve vertebra gövdesinin parçalanması ile seyreden tam (komplet) burst yaralanmalarını ifade eder.
• BT'de spinal kanal ön-arka çapı ve retropulse fragman boyutu ölçülür; spinal kanal darlığı derecelendirilir.
• Aksiyel görüntüde interpediküler mesafe genişlemesi ve korpus korteksinin parçalı kırık yapısı burst kırığında izlenebilir.
• Yerel kifotik açı ve vertebral yükseklik kaybı ölçülür; posterior duvar kırığı ve retropulsiyon tanımlanır.
• Lamina, spinöz çıkıntı ve fasetlerde kırık, ayrışma veya uyumsuzluk ek posterior gergi bandı hasarını düşündürür.
• Retropulsif fragmana eşlik eden epidural yumuşak doku yoğunluğu varsa hematom olasılığı belirtilir; bağ ve nöral yapı değerlendirmesi MR gerektirebilir.

Ölçütler ve sınıflamalar

AO Spine A3

Posterior duvar ve tek son plak tutulur; inkomplet burst kırığıdır.

AO Spine A4

AO Spine A4, komplet burst kırığı olarak sınıflandırılır.

Normalde

Torakolomber kırık değerlendirmesinde vertebral kama deformitesi, yükseklik kaybı, interpediküler mesafe genişlemesi ve spinal kanal darlığı ölçülebilir. Yaralı seviye komşu sağlam seviyelerle kıyaslanarak vertebral yükseklik kaybı, interpediküler genişleme ve spinal kanal darlığı niceliksel olarak belirlenir.

Ayırıcı tanı

Kama kırıklarında vertebral gövde ön yükseklik kaybı ve belirgin kama deformitesi izlenirken; burst kırıklarından farklı olarak pedikül genişlemesi ve kanal daralması yoktur.

Patolojik korpus kırığı

örn. spinal tümör invazyonu — travmatik burst kırığı morfolojisini ve nörolojik kompresyonu taklit edebilir.

Eski burst deformitesi

kenarlar kortikeleşmiş ve kanal içi fragman yeniden şekillenmiş olabilir; akut kırık çizgisi ve çevresel hematom desteği yoktur.

Tuzaklar

• Vertebra gövdesindeki kırık hattının yayılımı tek bir düzlemde değerlendirilirse detaylar kaçabilir; üç boyutlu görüntüleme ve çoklu düzlem analizi kırık desenlerinin tam anlaşılmasını sağlar.
• Kanal daralmasını yalnız en dar ölçüyle raporlama; retropulsif parçanın korpusun hangi bölümünden kanala uzandığını ve posterior eleman bütünlüğünü de tarif et.
• Vertikal lamina kırığını otomatik olarak posterior gergi bandı kopması sayma; kırık yönü ve faset-interspinöz hizalanma önemlidir.
• Tüm travma hacminde eşlik eden başka bir vertebra kırığını ara; çok seviyeli omurga yaralanmaları tek seviyeli incelemeyle dışlanamaz.

Kendini dene

1. Burst kırığının en önemli karakteristik özelliği nedir?

   • Posterior duvar kırığı ve kanala retropulsiyon
   • Anterior kama deformitesi ve yükseklik kaybı
   • Flexion-distraction mekanizması
   • Translasyonel kayma
   Cevabı göster

   Posterior duvar kırığı ve kanala retropulsiyon. Kaynak, burst kırığının en önemli karakteristik özelliğinin vertebral gövde posterior duvarının kırılması ve kemik fragmanlarının medüller kanala retropulse olması olduğunu belirtir.

2. Korpus kırığına eşlik eden fragman spinal kanal içine doğru yer değiştirmiş. Bu bulgu en çok hangi morfolojiyi destekler?

   • Burst kırığı
   • Gelişimsel kama
   • Schmorl nodu
   • İzole spinöz çıkıntı kırığı
   Cevabı göster

   Burst kırığı. Posterior korpus duvarı kırığı ve kanal içine retropulsiyon burst yaralanmasıdır. Diğer seçeneklerde korpus posterior duvarından kanala uzanan fragman beklenmez.

İlgili konular

• Ligamentöz fleksiyon-distraksiyon yaralanması

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 16 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.