Transforaminal sakral kırık (Denis zon 2) BT bulguları

Özet

Transforaminal kırık, yüksek enerjili pelvik travmada sakral nöral foramenlerden geçen dikey bir çizgiyle tanınır; osteoporotik hastada da foramen komşuluğuna uzanan yetersizlik kırığı görülebilir. İnce kesit kontrastsız BT ve çok düzlemli rekonstrüksiyon, hangi foramenlerin etkilendiğini, kanal ya da ala uzanımını ve kemik fragmanlarının sinir kökü çıkışına etkisini ortaya koyar. Kırığın nörolojik yaralanma riski taşıyan bölgeyi ve etkilenen foramenleri belirlemek için ince kesit kontrastsız BT ile çok düzlemli rekonstrüksiyon yapılmalı, nöral yapılar üzerindeki kompresyon veya traksiyon etkisi değerlendirilmelidir. Kontrastsız BT ve çok düzlemli rekonstrüksiyon, sakral kırıklarda nöral kompresyon veya traksiyon yaratan bulguları saptamak için değerlidir.

Okuma sırası

Sakral nöral foramenler. Sakrumda S1–S4 köklerinin çıktığı dört sakral forameni belirle; kırık hattının foramenlerle ilişkisini değerlendir.
Transforaminal kırık çizgisi. BT’de sakral kırık hattını ve sakral foramenlerle ilişkisini değerlendir.
Karşı ve etkilenen foramen. BT’de etkilenen foramenleri ve kırık morfolojisini kaydet; muayene edilemiyorsa sinir basısı veya traksiyonu için dolaylı bulguları değerlendir.
Sakral kanal ve karşı sakrum. Kırıkla ilişkili yumuşak doku yaralanmalarının türünü ve uzanımını BT’de değerlendir.

Faz ve pencere

Kontrastsız tanısal: Denis zon 2 kırığında dikey kırık hattı sakral foramen içinden geçer; BT, muayene edilemeyen hastada sinir basısı veya gerilme yaralanması için dolaylı bulgu sağlayabilir. BT, sakral kırıkların tanı ve morfolojik özelliklerini değerlendirmede standart yöntemdir; çok düzlemli rekonstrüksiyonlar kırığın erken tanınmasına yardımcı olur.

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

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

BT bulguları

Transforaminal çizgi — aksiyel görüntüde sakral foramen boyunca uzanır; koronal planda dikey devamlılık gösterir.
Etkilenen foramen düzeyi — Kırık hattı birden fazla sakral forameni etkileyebileceğinden her foramenin düzeyini ayrı ayrı belirt.
Foraminal daralma — BT’de sakral foramenlerin ve nöral elemanların ilişkisi değerlendirilir; muayene edilemeyen hastada BT, sinir basısı veya traksiyon yaralanması için dolaylı belirteç olabilir.
Kırık hattı foramenlerin medialinde sakral kanala uzanıyorsa zon 3 yerleşimi olarak tanımlanır.
Sakroiliak eklem ve ala uzanımı — Sakral kanatlar iliyumla eklemleşerek sakroiliak eklemleri oluşturur; kırık hattının bu yapılarla ilişkisini tarif et.
Bilateral dikey sakral kırık bileşenlerine transvers kırık eşlik ediyorsa U/H biçimli spinopelvik ayrışma örüntüsü araştırılır.

Ölçütler ve sınıflamalar

Denis sakral zonları: Zon 1 kırık foraminaların lateralinde, zon 2 bir veya daha fazla foramen içinden, zon 3 ise foraminaların medialinde sakral kanal boyunca uzanır. Zon 2'nin belirleyici anatomik ölçütü transforaminal seyirdir.
AO Spine sakral kırık sınıflaması: A tipi alt sakrum yaralanmalarını; B tipi posterior halka içinde spinopelvik bağlantısı korunan yaralanmaları; C tipi spinopelvik ayrışmayı ifade eder. Foramen içinden geçen dikey hat, eşlik eden instabilite bileşeniyle birlikte sınıflandırılmalıdır.

Normalde

Sakral nöral foramenler, S1-S4 sakral köklerinin çıkış yoludur. Kırık hattının sakral foramenlerle ilişkisini ve Denis zonunu, çok düzlemli BT rekonstrüksiyonlarında değerlendirin.

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 1 ala kırığı: çizgi sakral ala üzerinden uzanır ve foramenleri kesmez.
Denis zon 3 kanal kırığı: çizgi sakral kanal boyunca uzanır.
Sakral yetersizlik kırıkları, zayıflamış kemikte normal biyomekanik kuvvetlerle gelişen stres kırıklarıdır; osteoporoz bu kemik zayıflığının nedenlerinden biridir.

Tuzaklar

Sakral kırıkların tanı ve sınıflandırılmasında standart yöntem BT’dir; çok düzlemli rekonstrüksiyonlar erken tanıya yardımcı olur.
Foraminal daralmayı değerlendirirken kırık fragmanlarının konumunu ve eşlik eden yumuşak doku yaralanmalarının uzanımını BT’de incele.

Kendini dene

Sakral kırık hattı bir sakral foramenden geçiyor. Denis sınıflamasına göre kırık hangi zondadır?
Cevabı göster
Zon 2. Foramen içinden geçen kırık Denis zon 2'dir. Zon 1 transalar, zon 2 transforaminal, zon 3 ise santral yerleşimlidir.
Muayene edilemeyen sakral kırıklı hastada BT, sinir basısı veya traksiyon yaralanması açısından nasıl katkı sağlar?
Cevabı göster
Sinir basısı veya traksiyon yaralanması için dolaylı bulgu sağlayabilir. Muayene edilemeyen hastada BT, sinir basısı veya traksiyon yaralanması için dolaylı bulgu sağlayabilir.

İlgili konular

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 25 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.