Transvers sakral kırık

Özet

Transvers sakral kırıklar, düşük enerjili travma sonrası görülen yetersizlik kırıklarından yüksek enerjili travmayla oluşan bilateral dikey ve yatay bileşenli spinopelvik ayrışmaya kadar farklı örüntülerde görülebilir. Kontrastsız BT, kırığın sakral segmentini, fragmantasyonu, kifotik angulasyonu, translasyonu ve kanal lümenine etkisini gösterir. Sagittal MPR yatay hattın ve deformitenin değerlendirilmesinde, koronal MPR ise eşlik eden dikey bileşenleri aramada önemlidir. Eşlik eden U/H tipi bağlantı kopmasını atlamak instabiliteyi ve olası kanal/foramen yaralanmasını eksik tanımlar.

Faz ve pencere

Kontrastsız tanısal

Kemik penceresinde sakral korpus veya posterior elemanları çaprazlayan yatay lusent çizgi, kortikal basamak ve olası angulasyon/deplasman görülür; retropulse fragman kanal boşluğunu daraltabilir. Kırık morfolojisi için kontrast fazı gerekmez.

BT bulguları

• Transvers kırık hattı — korpus boyunca sağ-sol yönde uzanır; sagittal planda kesintili korteks ve yatay lusensi izlenir.
• Kırık seviyesi — S1-S2 bileşkesi, sakral korpus veya daha kaudal segment ilişkisini açıkça belirt; seviye deformite yorumunu değiştirir.
• Kifotik angulasyon — üst ve alt sakral parçaların eksenindeki açısal kırılma sagittal MPR'de görülür.
• Posterior translasyon — kraniyal parçanın kaudal parçaya göre geriye kayması kanal konturunu bozabilir.
• Kanal içi fragman — posterior korpus duvarından kopan parça sakral kanala taşabilir; aksiyel ve sagittal planda takip et.
• Eşlik eden dikey çizgiler — koronal MPR'de bir ya da iki foramen/ala boyunca uzanıp U, H, T veya λ biçimi oluşturabilir.
• Kraniyal ve kaudal fragmanların deplasman yönünü ve sakral kanaldaki kemik daralmasını BT'de tarif edin; BT sinir basısı veya gerilmesine ilişkin dolaylı bulgular gösterebilir, ancak nörolojik yaralanmayı tek başına kesinleştirmez.

Ölçütler ve sınıflamalar

Roy-Camille / Strange-Vognsen-Lebech transvers kırık sınıflaması

Roy-Camille tip I örneğinde kifotik deformite görülebilir; tip II üst sakral fragmanın distal segmente göre posterior, tip III ise anterior translasyonuyla tanımlanır; Strange-Vognsen–Lebech'in eklediği tip IV, S1 korpusunda segmental parçalanma ile karakterizedir. Deformiteyi sagittal MPR’de, parçalanmayı aksiyel kesitlerde doğrula.

Denis zonları

Sakral kanala uzanan transvers kırık, Denis zon III örüntüsüyle uyumludur. Foramen düzeyindeki sakral kırık bileşenleri Denis zon II veya III kapsamında yer alabilir.

Normalde

Normal sakral korpuslar kaynaşmış yapı oluşturur; posterior kortikal kontur ve sakral kanalın kemik sınırı kesintisizdir. Kırık seviyesini komşu segmentlerle kıyaslayarak yatay kortikal çizgiyi, açı değişimini, translasyonu ve kanal yönünde kemik çıkıntısını araştır.

Ayırıcı tanı

Sakral yetersizlikte yatay bileşen

çoğu kez bilateral dikey alar çizgilerle birlikte ve belirgin travmatik deplasman olmadan H biçimi verir.

Sakrokoksigeal eklem konturu

eklem aralığı ve düzgün kortike yüzeyler kırık hattındaki kortikal kesinti/angulasyondan ayrılır.

Doğumsal segmentasyon varyantı

düzgün kortike sınırlar ve uyumlu disk/eklem aralığı keskin, düzensiz travmatik hattın aksinedir.

Denis zon 2 dikey kırığı

foramenden kraniokaudal uzanır; transvers korpus hattı oluşturmaz.

Tuzaklar

• Yatay çizgi yalnız tek düzlemde görünüyorsa hacim etkisi veya kısmi füzyon çizgisi olabilir; sagittal ve koronal devamlılığı ile kortikal basamağı doğrula.
• Alt sakrumdaki küçük transvers kırıklar kemik penceresinde gözden kaçabilir; S2-S5 korpuslarını ve sakrokoksigeal bileşkeyi ardışık sagittal görüntülerde tara.
• Yalnız transvers bileşeni adlandırmak dikey kanat kırıklarını saklayabilir; koronal reformatta iki sakral ala boyunca tam tarama yap.

Kendini dene

1. Roy-Camille sınıflamasında, üst sakral fragmanın distal segmente karşı posterior translasyonu ile karakterize olan sakral kırık tipi hangisidir?

   • Tip I
   • Tip II
   • Tip III
   • Tip IV
   Cevabı göster

   Tip II. Kaynaklar, Tip II sakral kırıkları üst fragmanın alt segmana göre posterior kayması ile tanımlamaktadır.

2. Sagittal BT'de transvers sakral çizgiye ek olarak iki dikey alar hat seçiliyor. Hangi ek değerlendirme gerekir?

   • Spinopelvik devamlılık
   • Karaciğer segmentasyonu
   • Üreter opasifikasyonu
   • Akciğer nodülü
   Cevabı göster

   Spinopelvik devamlılık. İki dikey ve bir transvers bileşen U/H biçimli spinopelvik ayrışma oluşturabilir; koronal MPR ve pelvik bağlantılar kontrol edilmelidir. Diğer seçenekler sakral kırık örüntüsüne ilişkin değildir.

İlgili konular

• Sakral kanal kırığı (Denis zon 3)
• Sakral U/H tipi kırık ve spinopelvik ayrışma
• Transforaminal sakral kırık (Denis zon 2)

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 4 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.