Torakolomber kama kompresyon kırığı BT bulguları

Özet

Kama kompresyon kırığı, travma sonrası veya düşük enerjili yüklenmede vertebra korpusunun özellikle ön bölümünün çökmesiyle görülür. BT, son plak impaksiyonunu, kortikal kırık hattını ve posterior duvarın korunup korunmadığını hızla ortaya koyar; posterior duvar tutulumu varsa yaralanma basit kama kırığı olarak adlandırılmamalıdır. Akut ve eski deformiteyi ayırmada kırık hattı, kortikal kontur ve eşlik eden yumuşak doku bulguları yardımcıdır, ancak kırık yaşını kesinleştirmede MR kemik iliği ödemini gösterir. Posterior duvar uzanımı veya eşlik eden instabilite atlanırsa kanal riski ve yaralanma sınıflaması eksik kalabilir.

Okuma sırası

Torakolomber korpuslar. Sagittal kemik rekonstrüksiyonunda T12–L2 bileşkesini bul ve komşu korpusların ön duvar hizasını takip ederek yükseklik kaybının merkezini belirle.
Kırık son plağı. Çöken son plak boyunca trabeküler sıkışma ve kortikal basamaklanma ara; kırık çizgisinin hangi son plakla ilişkili olduğunu göster.
Korpus ön ve arka duvarı. Ön korpus yüksekliğini üst ve alt komşu seviyelerle kıyasla, sonra posterior korteksi aksiyel kesitlerde de kesintisiz izleyerek burst bileşenini dışla.
Kırık düzeyi ve korpus konturu. Fokal kifotik açılanmayı tarif et ve keskin kortikal kırık hattı ile kortike yeniden şekillenmeyi ayır; BT tek başına ödemin yaşını belirlemez.
Posterior elemanlar ve spinal kanal. Son olarak pedikülleri, posterior elemanları, kanal çapını ve komşu seviyeleri tarayarak eşlik eden kırık veya retropulsiyon olup olmadığını göster.

Faz ve pencere

Kontrastsız tanısal: İnce kesit kontrastsız BT'nin kemik algoritmalı sagittal ve koronal rekonstrüksiyonlarında ön korpus yüksekliği kaybı, son plakta çökme ve kortikal kesinti izlenir; kırık morfolojisi için intravenöz kontrast gerekmez.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

Ön korpus kama biçimli alçalır; komşu sağlam vertebraların konturlarıyla karşılaştırıldığında ön yükseklik kaybı belirgindir.
Üst veya alt son plakta fokal çökme ve trabeküler impaksiyon görülür; karşı son plağın ve posterior duvarın devamlılığı ayrıca izlenir.
Akut kırık lehine keskin radyolüsent hat korteksi keser veya son plak altında uzanır; tek başına kemik iliği yoğunluğu BT'de yaş tayini sağlamaz.
Posterior korpus duvarının düzgün ve kesintisiz kalması izole A1 kama morfolojisini destekler; duvar fragmanı kanala taşmışsa burst morfolojisi düşünülür.
Fokal kifotik açılanma yaralanan seviyede ölçülür ve komşu disk aralıkları ile vertebral hizalanma üzerinden tarif edilir.
Paravertebral yumuşak doku şişliği veya hematom akut travmayı destekleyebilir; yokluğu kırığı dışlamaz.
Kronik deformitede kortikal kenarlar yeniden şekillenmiş ve kortike görünür; keskin akut kırık çizgisi genellikle yoktur.

Ölçütler ve sınıflamalar

AO Spine A1: Bir veya iki son plak tutulabilir; kırık hatları birbirine bağlanmaz ve posterior korpus duvarı tutulmamıştır. Posterior duvar kırığı varsa A1 kullanılmaz.

Normalde

Normal torakolomber korpusta ön ve arka duvarlar paralel, son plaklar düzgün konkav veya hafif düz konturlu, korpus yüksekliği komşu seviyelerle uyumludur. Aynı sagittal düzlemde ön korpus yüksekliğini, son plak çizgisinin kesintisizliğini ve posterior duvarın kanal sınırına göre konumunu kıyasla.

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 s1338; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Burst kırığı: posterior korpus duvarında kırık ve kanala doğru retropulsiyon izlenir.
Eski kompresyon deformitesi: kortikal kenarlar yeniden şekillenmiş ve kortike görünür; akut keskin kırık çizgisi olmayabilir.
Schmorl nodu, intervertebral diskin son plak üzerinden vertebra korpusu içine fokal herniasyonudur.
Patolojik kırık: litik veya sklerotik kemik lezyonu, pedikül tutulumu ya da yumuşak doku kitlesi eşlik edebilir.
Gelişimsel kama vertebra: düzgün kortike kontur ve kronik şekil değişikliği vardır; akut kortikal kesinti beklenmez.

Tuzaklar

Ön duvar çökmesini tek başına A1 diye sınıflama; sagittal ve aksiyel kesitlerde posterior duvarın her iki kenarını izle.
Kronik osteoporotik çökmeyi yeni travma olarak yorumlama; kortikal kenarların kortikasyonu ve eski görüntülerle karşılaştırma yardımcıdır.
BT'de kırık hattının görünmemesi akut kırığı dışlamaz; ağrı düzeyiyle uyum sürüyorsa MR'da kemik iliği ödemi değerlendirilir.
Bir vertebra kırığı bulunduğunda travma BT'sinin diğer seviyelerinde ek kırık aramayı bırakma; çok seviyeli ve atlanan yaralanmalar mümkündür.

Kendini dene

T12'de tek son plak çökmesi ve ön yükseklik kaybı var; posterior duvar kesintisiz. En uygun AO morfolojisi hangisidir?
Cevabı göster
A1 kama kırığı. Tek son plak impaksiyonu ve posterior duvarın korunması A1 ile uyumludur. AOSpine sınıflamaya göre A tipi yaralanmalar kama impaksiyonu, bölünme, pençe, eksik burst ve tam burst alt tiplerini kapsar; B tipi yaralanmalar posterior gergi bantının kemikli veya osteo-ligamentöz kopmasını ifade eder.
Ön korpus çökmesine ek olarak posterior duvar kırığı ve kanala doğru yer değiştirmiş kemik fragmanı görülüyor. Hangi kırık morfolojisi en uygundur?
Cevabı göster
Burst kırığı. Posterior duvar tutulumu burst kırığı morfolojisiyle uyumludur; komplet burst kırığında her iki son plak ve posterior vertebral duvar tutulur.

İlgili konular

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 3 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.