Sakral kanal kırığı (Denis zon 3) BT bulguları

Özet

Sakral nöral foraminaların medialinde yer alan ve sakral kanalı tutan kırıklar yüksek enerjili travmada transvers, kompleks veya spinopelvik ayrışmanın parçası olabilir ve sakral sinir kökleri ile kauda ekuina için kritik risk taşır. BT, sakral kırıkların tanı ve karakterizasyonunda standart incelemedir. Denis zon 3 kırıkları yüksek nörolojik yaralanma riski taşır; U- veya H-biçimli birleşik kırıklar ve bilateral longitudinal kırıklar spinopelvik ayrışma örüntüsünü tanımlar.

Faz ve pencere

Kontrastsız tanısal: Kırık hattı nöral foramenlerin medialinde yer alarak sakral kanalı tutar; yüksek transvers hat, displasman veya retrolistezi eşlik edebilir. BT, sakral kırıkların tanı ve karakterizasyonunda standart incelemedir.

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

KemikG 1800 / M +400
Yumuşak dokuG 400 / M +40

BT bulguları

Foramenlerin medialinde ve kanalda kırık — çizgi sakral nöral foraminaların medialinde yer alır ve kanalı tutar; tek kesitte değil ardışık seviyelerde izlenir.
Kanal içi kemik fragmanı — sakral kırıkta kanal içinde kemik fragmanı görülebilir.
Kanal konturu — BT’de kanal içindeki kemik fragmanı ve kırık deplasmanı tanımlanabilir.
Transvers bileşen — sakral kırıklarda transvers hat yüksek yerleşimli olabilir; eşlik eden longitudinal hat transforaminal veya foramenlerin medialinde yer alabilir.
Bilateral longitudinal kırıklar veya U/H biçimli birleşik kırıklar spinopelvik ayrışma örüntüsünü gösterebilir.
Presakral hematom ve pelvik eşlikçiler — yumuşak doku penceresinde hematomu, iliak kanat ve SI eklem yaralanmalarını ara.

Ölçütler ve sınıflamalar

Sakral kırık karakterizasyonu için MPR kesit kalınlığı: BT standart incelemedir; 1–2 mm kesit kalınlığı bu kaynaklarda belirtilmemiştir.
Denis sakral zonları: Zon 1 foraminaların lateralinde, zon 2 foramen içinden, zon 3 foramenlerin medialinde ve sakral kanal bölgesindedir. Üst sakrumun S4 üzerindeki transvers kırıkları tipik olarak Denis zon 3'ü tutan kırıklar olarak değerlendirilmiştir.
Modified Roy-Camille: Spinopelvik ayrışmadaki transvers bileşeni deformite ve deplasman yönüne göre tanımlar: tip I kifotik açılanma, tip II kifozla retrolistezis, tip III belirgin öne translasyon, tip IV S1 korpusunda parçalanma. Sakral korpus-kanal kırığını tek başına Denis zonu ile karıştırmadan morfolojiyi ayrıca yaz.

Normalde

Denis sınıflamasında zon 3, nöral foraminaların medialindeki sakral kanalı kapsar. Kırıklı segmenti komşu üst-alt seviyeler ve karşı tarafla kıyaslayarak duvar kesintisi, kanal içi kemik yoğunluğu ve ön-arka çapta asimetri ara.

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 s0119; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Denis zon 2 transforaminal kırık: çizgi nöral foramen içinden geçer, ancak medial kanalı tutmaz.
Sakral kanalın anatomik konumu: Denis zon 3, nöral foraminaların medialindeki sakral kanalı kapsar.
Sakral yetersizlik kırıkları düşük enerjili travmayla oluşabilir; U- veya H-biçimli örüntülerde intrinsik instabilite gösterebilir.
Sakral tümör: medüller destrüksiyon ve yumuşak doku kitlesi kırık hattı/retropulsed kortikal fragmandan farklıdır.

Tuzaklar

Transvers kırık hattını sakral kırık morfolojisinin bir bileşeni olarak değerlendir; kaynaklar düzlemlere göre görünürlüğünü karşılaştırmıyor.
Kanal fragmanını kırık morfolojisiyle birlikte BT’de değerlendir; kaynaklar normal kortikal çıkıntıyı veya kısmi hacim etkisini tarif etmiyor.
BT, hasta muayene edilemiyorsa sinir basısı veya traksiyon yaralanması için dolaylı bir gösterge olabilir.

Kendini dene

Sakral kırıkta kemik fragmanının uzanabileceği ve sinir köklerini sıkıştırabileceği yapı hangisidir?
Cevabı göster
Sakral kanal. Sakral kırık fragmanları sakral kanala uzanabilir veya sinir köklerini sıkıştırabilir.
Bilateral longitudinal sakral kırıklar U biçimli birleşik bir kırık örüntüsü oluşturuyor. Bu örüntü nasıl adlandırılır?
Cevabı göster
U tipi spinopelvik ayrışma. U biçimli birleşik sakral kırıklar spinopelvik ayrışma örüntüsünü tanımlar.

İlgili konular

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 21 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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