Hyperextension Kukuvadza
- Hangman's Fx aka inoshungurudza spondylolisthesis yeC2 ine kuparara kwepars interulaticularis kana pedicles (isina kugadzikana)
- MVA ndicho chinonyanya kukonzera
- Mechanism: kukurumidza kugadziriswa kwepamusoro C / S yakafanana nekutongwa kwekutonga (isina kumboonekwa uye kufa kwevakawanda inokonzerwa neyefixiation)
- Secondary flexion inogona kuchema PLL uye disc
- Kukuvadzwa kunobatanidza: 30% ine imwe c-spine fx kunyanya Extension teardrop paC2 kana C3 nekuda kwekudzingwa neVOSE
- Cord kupera simba kunongowanikwa mu 25% nemhaka yezvibhakane zvisingabatanidzi uye kuwedzera kwechirwere
- Hangman fx nekuwedzera teardrop
- Cervical degeneration uye yapfuura fusion ndiyo chinhu chinokosha chinokonzera chikonzero nekuda kwekushayikwa kwekufamba uye kusabereka, kupa C / S nyore kuputsika
- Kufananidza: kutanga x-radiography ipapo CT iyo inobatsira kuderedza imwe kukuvadza kwakafanana nechikamu / pedicle Fx zvakare. MRI inogona kubatsira kana yakaoma neVertebral A. kukuvara
- Kutungamira: kana chirwere che 1 kukuvadzwa ndokuvhara kuburitsa uye kumira kwemberi kwemasvondo e4-6, halo bracing kana mhando 2 (> 3-5mm kusununguka) Fx / kusagadzikana, anterior kana posterior spinal fusion kuC2-3 kana aina 3 Fx (> 5 -mm kusununguka)
- Extension teardrop Fx (yakasimba) inogona kusanzwisisika kana ikaiswa muwedzerwa
- Kuvhiringidzwa kwemuviri wepasi wepasi weAIDS. Zvakawanda zvakaratidzwa kune vakwegura vane maitiro akadai C / S spondylosis
- Chinyorwa chemafirimu: kamera kadiki kakanyanya-pasi-pasi, pasina kupesana kwekugadzirisa kugadzirisa. Kazhinji paC2 kana C3 nekuda kwekukurumidza kushungurudzika uye KUDZWA kwose
- Kugadzirisa: central cord syndrome (m / c isina kukwana tsvimbo yekukuvara) esp. mupamusoro-soro spondylosis uye canal stenosis nekunyara kwe ligamentum flavum uye maosteophytes
- Kutungamira: zvakaoma collar kusungirirwa
Mukati
Vertical (axial) Kunyanya Kukuvadza
- Jefferson Fx (akatumidzwa zita reBritish neurosurgeon akarijekesa) (asina kugadzikana asi ane hutano hwakasimba Fx) 7% yezvose zvinokonzerwa neC / S. Kugadzikana kunotarisa kana mutsara unopfigira usinganzwisisiki kana wakabvaruka, unogona kuonekwa nekuwanda kwevanhu vakawanda veC1 pamusoro peC2> 5-mm pamwe chete (kuruboshwe)
- Mechanism: C1 compression (semuenzaniso, kupinda mumvura isina kudzika) zvichikonzera kuputika kweFx-classically 4-zvikamu zvemukati uye shure kwechikamu cheC1. Kusiyana kunovapo.
- Matambudziko: 50% inoratidza zvimwe C / S Fx, 40% kuratidza Mhedziso C2 Fx esp. kana kuwedzerwa uye kukwikwidza kunokonzera kuchiitika
- Kufananidza: x-radiography yakateverwa neC CT kuongorora kukuvara kwekurwadza uye kusagadzikana kwekukuvara kweC1. Cherechedza Jefferson Fx neshongwe uye inotenderera foramina fx inoda posterior occipital-cervical fusion (pasi pekufa kwechifananidzo).
- Kutungamira: kuoma kwemirasi isina kukwana kana gumbo rinenge richiputika risina kukwana. Halo brace kana fusion kana mutsara wepakati unoputika
Mishonga yeCervical Injuries Nenzira Dzakasiyana dzekutambudza
- Odontoid process fractures:
- Izvi zvinoitika-- nenzira dzakasiyana siyana, kubhururuka, kuwedzerwa, kumberi kwekuseri. Vakwegura vane yakanyanya spondylosis vari pangozi yakanyanya.
- Anderson & D'Alonzo kupatsanura (pazasi). Type 2 ndiyo yakanyanya kuwanda uye isina kugadzikana. Type 3 ine yakanakisa mukana wekuporesa d / t yakanyanya kubuda ropa muC2 muviri uye zvirinani kurapa kugona.
- Kufungidzira: x-radiography inogona kushaya Fx. CT kuongorora kunokosha.
- Pa x-rayography nyaya yekudzivirira kweDens pane lateral uye APOM maonero. CT icharatidza kuipa nekuiisa.
- Matambudziko: tsvimbo yekukuvara, kusabatana
- CT kuongorora: chimiro che2 chisina kuputika (chisina kugadzikana)
- Manejimendi: mhando 1 (alar ligament avulsion) yakanyanya kugadzikana- inoonekwa uye kurapwa neyakaomarara kora.
- Muchirwere vaduku, Halo brace inoshandiswa kubata chironga 2
- Vakwegura havaregi Halo
- Kushandisa C1-2 fusion kana isina kugadzikana Dx uye rwonzi zviratidzo kana zvimwe zvinonetsa zvinowanikwa
Kazhinji Radiographic Variants & Anomalies Simulating Pathology
- Chiremba muzongoza rinoratidzika zvakasiyana kwazvo kunyanya vana muduku kupfuura 10-yemakore.
- Kazhinji kusiyana; ADI 5-mm uye inogona kuwedzera kana kuderera pane mafashoni / yakawedzerwa maonero ne 1-2-mm
- C2-3 inogona kuonekwa semusana-subluxation pamusana pezvisizvo zvinokonzera kuvhiringidza vana (pasi pemuseve)
- Mishonga yehutachiona hwemhuka kazhinji inowedzera uye yakanyatsogadziriswa nekuda kwekuvapo kwechirwere chethambo
- Kuonekwa kweAAPOM kunooneka kwakasiyana nevana, uye mamwe asymmetry yeC1 mashizha akawanda ndeye (pasi pemusoro wepamusoro) uye haafaniri kusanganiswa naJefferson Fx
- Muvanhu vakuru, chero sarudzo kana kuti "kudarika" kweC1 masticular masticular pathological uye inogona kuratidza Jefferson fx
- Mafuta ekusimbisa masimba eAtlas synchondrosis muvana havafaniri kukanganiswa nemakumbo
- Pakupedzisira ossiculum terminal yeBergman isiri yakasiyana-siyana / inonyangadza yekusimbisa un-united mussification centre uye haifaniri kusanganiswa nerudzi rwemagetsi fx
- Os odontoideum
- Un-united united growth centre iyo iye zvino inofungidzirwa sekukuvadzwa kusingaoneki kwakashungurudza kukura kwakakwana mumwana muduku kudarika 5-makore-yakwegura
- Iyo inogona kuva chikonzero cheC1-2 kusagadzikana uye inofanira kuongororwa nemafungiro akawedzerwa uye akawedzerwa mhondi
- Hazvifaniri kuvhiringidzika nerudzi rwe2 Dens kuputika nokuti inowanzoratidzira zvakanyanya kuderera kwemapfupa
- Izvo zvisina kukwana agenesis agenesis yeC1 posterior arch
- Kuvharwa kweAnomal kweC1 posterior arch
- Haafaniri kunge akavhiringidzika nekuputsika
- Zvisinei, nzvimbo dzedunhu kana chungetedzo dzinogona kukura mushure mokutambudzika mune dzimwe nguva
- Zvichida zvisinganzwisisiki zvinomarara zvichikudzika nemhaka yekukundikana chondrogenesis uye kushambadzira kwemashure ekusimba ossification nzvimbo dzeAtlas
- Varwere vane Down syndrome vangave vachitambura nekuwedzera kushaya simba uye zvimwe zvisiri izvo
- Kuwedzerwa njodzi yekuderedzwa kweC1-2
- Burst Fx (isina kugadzikana) 2-columns yakanganisa
- Mechanism: kukanganiswa kwemaxiki neyemafuro mushure mekuwa uye MVAs
- Nharaunda ye thoracolumbar ndiyo inonyanya kunetseka nekuda kwekuwedzera kwechikwata chekufamba
- Key radiography: kupwanya kwakanyanya kuputsika uye kupunzika kwekureba kwemuviri, kudzoreredza kwemuviri wepashure uye kuomarara kyphotic kuora pane yekupedzisira maonero
- Pamusoro pechiratidzo chekutanga: interpedicular kuwedzera (pasi pejecha mutsvuku)
- Kufananidza: x-radiography inofanira kuteverwa neC CT kuongorora w / o kusiyana
- MRI kana chirwere chisina kugadzikana chisina kugadzikana pamusana petsambo kana kuora kamu
- Matambudziko: tambo inokanganisa nematombo anogadziriswa mapfupa
- Manejimendi: isiri-inoshanda kana neurologically isina kugadzikana uye <50% muviri unodzokororwa nekeyphosis shoma
- Kushanda (fusion) kana 50% kana kuti muviri wakawedzerwazve, laminar / pedicle Fx, neuro inopesana
18-Gore Rakarembera Mukadzi Achitevera Trampoline Accident
- AP & yekupedzisira L / S maonero
- Cherechedza zvakanyanya kudengenyeka kwechikafu, muviri unotaridzika uchienderera mberi kune zvimwe zvinhu
- Kuwedzera kwemafambidzani e-inter-spinous pakati pe T11-T12 (pasi pemuseve)
- Radiolucent fracture line inowanikwa kuburikidza neA T12 body pa AP kugadzira
- CT kuongorora kwakaitwa
- Sagittal yakagadziridza matanho eTracracic neLumbar CT muwindo refupa
- Cherechedza kunyanya kudzvinyirira kupera, iyo T12 muviri unowedzera kusvika pedicle uye lamin
- Dx: Chinhu chinokanganisa kuputika kwe T12
- MR imaging yakaitwa
- T2 Wl sagittal MRI
- Zvitsva: kugadzikana kwakanyanya kuputsika T12 muviri unowedzera kune posterior zvinhu zvinokonzera kukwidzwa kwezvinyorwa uye flavum ligaments
- Kugadzikana kwakanyanyisa kwetambo yakasara pamusoro pemakoni kunoratidzwa nechinomwe chisingaenzaniswi
- Dx: Chinhu chinoputika
- Chance Fx aka (Seatbelt Fx) - iko kuve-kukanganisa-kushungurudza (kusagadzikana)
- M / C mumucheto wepasi-thoracic-upper lumbar
- Zvose 3-columns zvinokundikana: chinyorwa 3 chakakonzerwa nekuvhiringidzwa, mapurumendi 1 uye 2 vanokundikana pakukanganiswa (Denis maitiro)
- Zvinokonzera: MVA, inowira
- Kufananidza: kutanga x-radiography inofanira kuteverwa neTV kuongorora w / o kusiyanisa kuongorora mapfupa emapfupa ekudzokorora. MRI inogona kubatsira kuongororodza ingangodaro yakakanganiswa uye michina inoputika
- Kutungamira: kwete-operative immobilization kana neuro isingaiti
- Operative decompression uye fusion
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
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Dr. Alex Jimenez DC, Msacp, RN*, CCST, IFMCP*, CIFM*, atn*
email: qeqeshi@elpasofunctionalmedicine.com
Akapihwa rezenisi saChiremba weChiropractic (DC) mu Texas & New Mexico*
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Dr. Alex Jimenez DC, MSACP, RN* CIFM*, IFMCP*, ATN*, CCST
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