Sakral U/H tipi kırık ve spinopelvik ayrışma

Özet

U/H tipi sakral kırıkta iki longitudinal sakral hat, bir transvers bileşenle birleşir ve omurgaya bağlı üst sakral segmentin pelvisle kemik devamlılığını keser. Yüksek enerjili düşme ve araç çarpışmalarında görülebilir; yetersizlik kırığında da benzer geometrik hatlar oluşabileceği için travma mekanizması ve deplasman birlikte yorumlanır. Kontrastsız BT'nin koronal, sagittal ve aksiyel MPR'leri kırık geometrisini, ayrışan segmentleri, kanal/foramen basısını ve eşlik eden pelvik halka hasarını ortaya koyar. Örüntüyü kaçırmak ciddi mekanik instabiliteyi ve kanal içi fragmanla ilişkili nörolojik riski gözden kaçırabilir.

Faz ve pencere

Kontrastsız tanısal

Kemik algoritmalı BT'de iki dikey sakral ala/foramen çizgisi ve bunları birleştiren yatay kırık U veya H konturu oluşturur; sagittal planda posterior translasyon, kifoz ve retropulse fragman görülebilir. Akut yüksek enerjili yaralanmada sakral kırığın değerlendirilmesinde BT tercih edilen yöntemdir.

BT bulguları

• İki dikey sakral hat — koronal reformatta sağ ve sol taraftaki çizgiler aladan, foramenden veya kanal komşuluğundan geçebilir.
• Birleştirici transvers hat — aksiyel ve sagittal MPR'de seviyesini, tamlığını ve dikey bileşenlerle bağlantısını belirle.
• U/H geometrisi — kesintisiz üst sakral blok ile alt sakrum arasındaki kırık konfigürasyonu pelvisin omurgaya tutunmasını bozar.
• Spinopelvik translasyon — kraniyal sakral parçanın posterior veya anterior kayması ile sakral kifoz sagittal planda gösterilir.
• Kanal ve foraminal fragman — posteriora itilmiş kemik parçası merkezi kanalı ya da nöral çıkış deliklerini daraltabilir.
• SI eklem/pelvik halka — iliak kanat, asetabulum ve anterior halka yaralanmaları ile presakral hematom eşlik edebilir; pelvis BT'sinin tamamını tara.
• U tipi sakral kırık spinopelvik ayrışmadır; sagittal BT rekonstrüksiyonu transvers bileşeni ve kırık deplasmanını değerlendirmeye yardımcı olur.
• AO Spine'da C0 deplase olmayan U tipi kırık, C2 transvers bileşeni olmayan bilateral tam B tipi kırıklar, C3 deplase U tipi kırıktır.

Ölçütler ve sınıflamalar

Deskriptif şekil sınıflaması

U veya H biçimi iki longitudinal bileşen ile transvers bağlantının görünümünü adlandırır. AO Spine sınıflamasında C1, arka pelvik stabilitesi korunmuş U tipi sakral kırık varyantı olarak tanımlanır.

Roy-Camille sınıflaması

Roy-Camille tip 2 U tipi kırık posteriora, tip 3 ise anteriora deplase olarak tanımlanır.

AO Spine sakral sınıflaması

C tipi yaralanma spinopelvik ayrışmayı ifade eder; transvers bileşenle tamamlanan dikey kırık düzeni C grubu içinde sınıflandırılır. Nörolojik durum ve hasta-özel değiştiriciler morfoloji kodundan ayrı kaydedilir.

Normalde

Normalde lomber omurga, sakrum ve iki iliak kemik arasında kesintisiz yük aktarım hattı vardır; sakral korteks ve SI eklem yüzleri düzgün konturludur. Koronal planda iki ala, sagittal planda sakral segment dizilimi ve aksiyel planda kanal/foramen açıklıkları karşılaştırılarak kemik köprü devamlılığındaki kopma ve segment kayması gösterilir.

Ayırıcı tanı

Bilateral sakral yetersizlik kırığı

H biçimi oluşturabilir; eşlik eden osteoporoz, ala boyunca sklerotik bant ve genellikle az deplasman destekler.

AO Spine'da yatay bileşeni olmayan longitudinal sakral kırıklar B tipi posterior pelvik yaralanma olarak sınıflanır; spinopelvik ayrışma ise omurga ile pelvik halka bağlantısının bozulduğu C tipi yaralanmadır.

AO Spine'da sakroiliak eklemin altında kalan deplase olmayan transvers kırık A2, deplase olan A3'tür; bilateral longitudinal ve transvers bileşenli U tipi kırıklar C grubunda değerlendirilir.

Sakrum tümörleri ile tümör dışı lezyonların görüntüleme özellikleri örtüşebilir; belirli örüntüler etiyolojiyi düşündürse de kesin tanı için biyopsi gerekebilir.

Tuzaklar

• Osteoporotik hastalarda bilateral dikey sakral ala kırıkları saptandığında, eşlik eden transvers bileşeni aramak için sagittal BT rekonstrüksiyonları da incelenmelidir.
• Yetersizlik kırığı U/H benzeri görünüm oluşturabilir; alar skleroz, kemiğin genel osteopenisi ve belirgin segment translasyonu olup olmadığını birlikte değerlendir.
• Sagittal BT rekonstrüksiyonu, deplase olmayan veya minimal deplase sakral kırıkların tanınmasında en duyarlı görüntüleme yöntemidir.

Kendini dene

1. BT'de iki dikey sakral çizgi, bunları birleştiren S2 transvers kırık ve posteriora kaymış kraniyal blok var. En uygun tanım?

   • U tipi ayrışma
   • İzole zon 1
   • İzole zon 2
   • Sakrokoksigeal çıkık
   Cevabı göster

   U tipi ayrışma. İki dikey kol ve birleştirici transvers bileşenle üst sakral blok pelvik bağlantısını kaybeder; bu U tipi spinopelvik ayrışmadır. Diğer seçenekler bu üç kollu geometriyi açıklamaz.

2. Bilateral alar dikey çizgiler ve yatay S2 bileşeni var; yaygın osteopeni, bant sklerozu ve belirgin translasyon yok. En olası eşlik eden mekanizma?

   • Yetersizlik kırığı
   • Sakral tümör
   • İzole kanal kırığı
   • Sakroiliit
   Cevabı göster

   Yetersizlik kırığı. Kaynaklar, osteopeni ve belirlenmiş alar bantlarla oluşan H/U tipi kırıkların yetersizlik kırığı ile uyumlu olduğunu belirtir.

İlgili konular

• Sakral kanal kırığı (Denis zon 3)
• Transvers sakral kırık
• Transforaminal sakral kırık (Denis zon 2)
• Sakral ala kırığı (Denis zon 1)

Kaynaklar

Bu sayfadaki 43 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 7 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.