Nzira yekutsvaga kwepfungwa yekutsvaga nzira yekutarisa Chikamu I

Imaging Diagnosis Management:

• Cervical spinal trauma & radiographic akasiyana simulating chirwere
• Cervical spine
• chirwere chemumajoini
• Neoplasms
• Kurwara
• Post-Surgical cervical spine

 

 

• Cranio-cervical nepamusoro yekervical kugadzikana inobva kune zvakadarika, zvakakwirira uye zvisingasviki mapoka eC1-C2 ligament, majekiseni ane simba, pamwe chete nemimwe michina mishoma

 

 

 

Cervical Trauma

• IC / S inonetseka kukuvara. Sei?
• Kugadzikana kwave kuchibayirwa kukufambira mberi kukuru
• Cervical vertebrae iduku uye inoparadzaniswa nevakawanda foraminae
• Musoro wacho hauna simba uye hunoita sevhisi isingawanzoiti kana masimba achiita zvinopesana nemagetsi
• Uyezve, C / S inowanzotarisana nehupenyu hunoita kuti iwedzere kutarisana nematambudziko
• Muvana vaduku, mishonga inowedzera mararamiro nekusana kwemazana musoro yakakura
• Mune vana, ruzivo rwekufambisa ruri paC2 / 3 nekudaro kukuvadza kunowanzoonekwa muchepamusoro C / S uye musangano weganiocervical. Muvana, SCIWORA inogona kuitika kana pasina uchapupu hwekuputsika huripo
• Muvanhu vakuru, ruzivo rwekufambisa iri paC5 / 6 nekudaro kugadzirisa zvakanyanya C / S zvinowanzoshungurudzwa nekutambudza zvikuru kunyanya panguva yekunyengera
• Cervical Trauma yakarongedzwa zvinoenderana nenzira dzekukuvara (Harris & Mirvis classification)

 

Kufungidzira Kukuvadza: Yakasimba vs. Yakasimbiswa

• Kutsemuka teardrop Fx (yakanyanya kuputsika, isina kugadzikana)
• Chibvumirano chechibvumirano chisingaiti (kukuvara kwakanyanya w / o kuputsika, kusagadzikana)
• Anterior subluxation (inogona kunge isina kugadzikana) inogona kunge yakakuvadza zvikuru
• Clay Shoveller Fx (yakadzika C / S SP evulsion, yakasimba)
• Simple wedge compression (yakawanda inobata Fx, yakasimba)
• Kufungidzirwa-kushandura pamwe chete neunilateral facet dislocation
• Iva nehana yakazara
• Ita kuongorora mumuviri kusanganisira kuongorora kwepfungwa
• Cherechedza nzira dze NEXUS (National Emergency X-radiography Shanduro Yokushandisa)

 

Imaging Techniques:

• Inotanga ne x-radiography kunyanya mumamiriro ezvinhu pasina chiito chakakosha chepfungwa
• Bvisa kusapindira kwematongerwe enyika maonero ekutanga
• Kana x-rayography isingakundiki asi mikana yakakura yekushungurudzika kwakanyanya uye kushaya njodzi kwemauro iko, CT kuongorora w / o kusiyana kunodiwa
• Funga nezveC CT kuongorora kune varwere vane hutano hwakagara huripo: advance spondylosis, DISH, AS, RA, mushure mekuvhiya musana, kuberekwa kwepenital (Klippel-Feil syndrome, nezvimwewo)

 

Vertical compression:

• Jefferson aka burst Atlas Fx (isina kugadzikana kana Transverse ligament yakabvaruka, cord kuparara mu 20-30% chete)
• Sei? Pamusana pezvidimbu zvekuparadzanisa uye kanjini kunowedzera
• Burst Fx yeTraracic kana kuti Lumbar spine (isina kugadzikana, rwonzi rwomuviri rukaita)

 

 

Nzira Yokuongorora Nayo Spinal Radiographs mumatambudziko eTrauma:

• Gadzirai 5-mitsara pane lateral view
• Cherechedza kana zvikamu zvakanyatsoenderana uye zvakasiyana
• Iva nechokwadi chekuenzanisa kwekukwirira kwe disc
• Cherechedza chero kuwedzera kana kufungidzira kwemafambidzani akasiyana-siyana
• Nyatsoongorora prevertebral soft tissues
• Ongorora nguva yeatlanto-meno (ADI)

 

 

• Mumamiriro ekutambudzika, kuongorora uye kujekesa kusarerekera kwakatangira kare
• Usaita mafungiro uye kuwedzerwa maonero mumatambudziko akadai masikati x-ray kana CT kupenya kusabatanidza kusagadzikana kwakanyanya
• Chengetedza zvakanyanya ku prevertebral soft tissues
• Kana yakanyanyisa kupfuura yakasvibirira miganhu, funga zvakanyanya pashure pechirwere chinotyisa
• Kubwinya kwemasimba uye kupararira kwemashure ekudzika kwemasikisi uye zvipfeko zvinokwikwidzana zvinogona kuva chinhu chinokosha chekubvarura kwemashure emakumbo

 

 

Kufungidzira Kukuvara (M / C Mechanism)

• Dzimwe nguva kakawanda mu-sub-axial C / S C-3-C7)
• Kukuvara kwakashata:
• Flexion teardrop kuputsika (M / C C5 & C6) v. Kusagadzikana
• Chinhu chakakosha mativi:

• Makuru "teardrop" katatu anterior body fragment
• Fanning we SPS, post-disc uye chikwata chichiwedzera kuratidza kuputika kwepamusoro pemaginal ligaments uye kusagadzikana
• A posterior shift of the vertebral body breaks suggests direct anterior cord / compression containers
• Bulging prevertebral soft tishu> 20-mm paC6-7
• 80% yematambudziko angave akaoma rutivi rwomuviri panzvimbo iyo kana kuti ave nekukurumidza kupora muviri mushure mekunge

 

 

Acute Neck Trauma. Ndezvipi zvinonyanya kukoshesa mavara edzimba? Chii chinozivikanwa?

 

 

• CT kuongorora w / o kusiyanisa nekugadzirisa sagittal. Cherechedza C7 Flexion teardrop Fx.
• CT inogona kubatsira nekuwedzera kududzira uye kugadzirira kushandiswa
• Ngatitevere naMM imaging uye kuongorora kwekukuvara kwepfungwa

 

 

• Fluid sensitive (T2) sagittal MRI slice yeKutsvaira kwemajeri ekuparara kweC4 uye zvichida C5
• Cherechedza chiratidzo chekuwedzera kwechiremera mumudonzvo nemiganhu yakapoteredza inoratidza cord edema uye ischemia
• Kutungamira: neurosurgical ne spinal fusion
• Matambudziko:
• Quadriplegia / paraplegia
• Zvirwere zvepumusoro
• Kuremara, kuchinja muhupenyu hwehupenyu
• Kunoderedza kutarisira upenyu

 

 

• Chibvumirano chechibvumirano chakasununguka (chisina kugadzikana)
• Chimiro: Kufungidzika-kukanganisa kuora
• Chinobudiswa chemashoko makuru: mutumbi wakabuda mumusha 50% kana kupfuura
• Zvikamu zvakanyanyisa uye zvakakiwa (zvinogona kukonzerwa nemifananidzo yakasara)
• Kukuru kuputika kwemitsipa
• Mikana yekambo yakasimba kudzvinyirira uye kupora simba
• Varwere vane mishonga inokonzera kushanduka uye kuchinja kunogadzirisa vari pangozi yakakwirira
• Pakutanga x-radiography ndiyo danho rokutanga

 

 

CT kupenya w / o Kusiyana kunokosha:

 

 

• Kuwedzera kududzira kwekukuvara uku
• Facet fractures, pedicle fracture
• Management planning

Sagittal fluid sensible MRI yepasi rose C5 facet dislocation, yakareba ischemic cord kukuvara, uye kukuvara kwemashure kunotapira

 

 

• Kutungamira:
• X-radiography, ipapo CT kuongorora kunowanzovhara kuderedzwa (esp. Kana murwere achiziva)
• Yakateverwa mune dzimwe nyaya dzakaoma zvakaitwa neMRI uye zvakare kutarisirwa
• Kana murwere akasvinura uye akachengeteka neurologically, CT uye kupfigwa kwekuvhara zvakakwana
• Dambudziko rakaoma uye rakakundikana kupera kuderedzwa kunogona kushandiswa kugadzikana
• Matambudziko: musana kuora uye kuora mwoyo
• Delayed ligamentous laxity uye kusagadzikana

 

 

• • Unilateral facet dislocation (kubhururuka-kutenderera kukuvadzwa) kuderera kudarika kuparadzaniswa kwemazana maviri
  • Kuwanda kunowanzosvibiswa kukuvadzwa kwechiberekero chemuviri pa x-radiography
  • Chinhu chakakosha chimiro: muviri wakashandurwa zvakashandurwa 25% maitiro anooneka asina kumira uye akajeka, SPs inotenderera mberi
  • Kliniki inogona kuendeswa seimwe-sided radiculopathy esp. C6 kana C7
  • CT kuongorora inodiwa kuti uongorore zvimwe zvinyorwa / pedicle fractures
  • Pre-kuderedza kuongorora uye kuronga kuchengeta
  • Kutungamira: rakapfigwa kucheka esp. mune murwere unoziva
  • Matambudziko: acute disc herniation / retropulsion, rinokonzera kukanganisa, kuora kweuropi

Nzira yeApinal Trauma Yokufungidzira

Zvidzidzo:

• emedicine.medscape.com/article/824380-overview
• emedicine.medscape.com/article/248236-overview#a9
• emedicine.medscape.com/article/397896-overview#a3
• www.aafp.org/afp/1999/p331.html