Sakral ala kırığı (Denis zon 1)

Özet

Sakral kırıklar yüksek enerjili travmayla görülebilir; osteoporotik yaşlılarda yetersizlik kırıkları düşük enerjili travma veya günlük yaşam stresleriyle gelişebilir. BT, travmatik sakral kırıkları tanıma ve karakterize etmede standart incelemedir; eşlik eden yumuşak doku yaralanmalarının tipini ve kapsamını gösterebilir, yetersizlik kırıklarının erken saptanmasında ise MR daha duyarlıdır. Yetersizlik kırığında BT'de sakroiliak eklem yakınında belirsiz osteoskleroz ve lineer ya da kurvilineer hipodens kırık hattı görülebilir. Bilateral dikey alar çizgilerle birlikte yatay bileşenin gözden kaçması H biçimli kırık örüntüsünün tanınmasını güçleştirebilir; sakral yetersizlik kırıkları metastazla karışabilir.

Faz ve pencere

Kontrastsız tanısal

Kemik algoritmasında ala içinde ince lineer lusensi, kortikal kesinti veya impaksiyon; yetersizlik kırığında sakroiliak ekleme paralel medüller skleroz görülebilir. Yetersizlik kırığı kuşkusu sürüyorsa, BT'de kırık hattının görülmemesi kırığı dışlamaz; MR gizli yetersizlik kırıklarını saptamada daha duyarlıdır.

BT bulguları

• Ala kırık hattı — sakral foraminaların lateralinde ve sakroiliak eklemin medialinde uzanır.
• Kortikal basamak — anterior veya posterior alar kortekste kesinti, impaksiyon ya da küçük ayrılmış fragman şeklindedir.
• Yetersizlik sklerozu — sakroiliak ekleme paralel, dikey ve bant biçimli yoğunlaşma kırık hattı eşlik etmese de görülebilir.
• Bilateral ala tutulumu — iki taraftaki dikey çizgilerin S1-S2 düzeyinde yatay bir hatla birleşip birleşmediğini koronal planda kontrol et.
• Sakroiliak eklem ilişkisi — çizginin eklem yüzüne ulaşması ve eklem aralığı basamaklanması pelvik halka stabilitesi açısından ayrıca tariflenir.
• Yumuşak doku — presakral hematom veya çevre kas planlarında ödem eşlik edebilir; kemik penceresindeki çizgiyle aynı tarafta ara.

Ölçütler ve sınıflamalar

Denis sakral zonları

Denis sınıflamasında zon 1 sakral kanat (ala), zon 2 sakral foramen bölgesi, zon 3 sakral kanal bölgesidir. Denis zon 1, sakral kanat (ala) bölgesindeki kırıkları tanımlar.

AO Spine sakral kırık sınıflaması

A tipi alt sakrokoksigeal, B tipi posterior pelvis, C tipi ise spinopelvik yaralanmaları kapsar. Ala kırığı tek başına Denis zonuyla tariflenebilir; eşlik eden örüntü daha üst AO tipini belirleyebilir.

Normalde

Sağ ve sol alayı aksiyel ve koronal düzlemde karşılaştır; kırık tarafında kortikal basamak, çizgisel lusensi veya ekleme paralel yeni sklerotik bant olup olmadığını değerlendir.

Ayırıcı tanı

Sakral yetersizlik kırığı

osteoporotik kemikte ekleme paralel bant skleroz ve sıklıkla bilateral alar dağılım gösterir.

Sakroiliit

eklem yüzlerinde erozyon, skleroz ve eklem aralığı değişikliği ön plandadır; tek bir alar kortikal kırık çizgisi beklenmez.

Osteoblastik metastaz ayırıcı tanısında, sakroiliak ekleme yakın skleroz ve lineer ya da kurvilineer hipodens kırık çizgisi yetersizlik kırığını destekleyebilir.

Tuzaklar

• Yetersizlik kırığında belirgin lusensi olmayabilir; ala içindeki paralel sklerotik bant ve kortikal kontur bozukluğu için kemik algoritmasını gözden geçir.
• Bilateral alar kırıklarda koronal MPR'de eşlik eden yatay bileşen araştırılmalıdır; bilateral dikey çizgilerle yatay bileşen H tipi kırık örüntüsünü oluşturur.
• BT'de kırık hattı gösterilemeyen ancak yetersizlik kırığı kuşkusu süren hastada MR gizli kırığı saptamada daha duyarlıdır ve erken kemik iliği ödemini gösterebilir.

Kendini dene

1. Osteoporozlu hastanın BT'sinde SI ekleme paralel ala çizgisi, foraminalar korunmuş. Denis zonu hangisidir?

   • Zon 1
   • Zon 2
   • Zon 3
   • Roy-Camille tip II
   Cevabı göster

   Zon 1. Foramenlerin lateralinde kalan alar kırık Denis zon 1'dir. Zon 2 foramen içinden, zon 3 kanal medialinden geçer; Roy-Camille tipi transvers deplasman örüntüsünü tanımlar.

2. Bilateral alar sklerotik bantlara eşlik eden kortikal yıkım ve yumuşak doku kitlesi hangi tanıyı daha olası kılar?

   • Yetersizlik kırığı
   • Osteoblastik metastaz
   • Sakroiliit
   • Kemik adacığı
   Cevabı göster

   Osteoblastik metastaz. Destrüksiyon ve kitle metastaz lehinedir. Yetersizlik kırığı genellikle ekleme paralel bant oluşturur; sakroiliit eklem yüzlerini, kemik adacığı ise sınırlı homojen odağı tutar.

İlgili konular

• Transforaminal sakral kırık (Denis zon 2)
• Sakral U/H tipi kırık ve spinopelvik ayrışma
• Transvers sakral kırık

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 13 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.