Habka Sawirka Dhaawaca laf-dhabarka ee lagu ogaanayo Qaybta I

Maareynta ogaanshaha sawirka:

• Dhaawaca laf-dhabarka ilmo-galeenka iyo noocyada shucaaca ee matalaysa cudurka
• Laf-dhabarta ilmo-galeenka
• Arthritis
• Neoplasms
• Caabuqa
• Qalliinka ka dib laf dhabarta ilmo-galeenka

• Cranio-intervical iyo xasiloonida ilmo-galeenka sare waxay ku xiran tahay xargaha goos gooska, sare iyo hoose ee xuubka C1-C2, seedaha alar, oo ay la socdaan dhowr seedyo kale

Dhaawaca afka ilmagaleenka

• C/S waxay u nugul tahay dhaawac. Waa maxay sababtu?
• Xasilooni waxa loo huray dhaq-dhaqaaq weyn
• Laf-dhabarta afka ilmo-galeenka waa yar yahay waxaana kala gooyay foramine badan
• Madaxu si aan qiyaas lahayn ayuu u culus yahay wuxuuna u shaqeeyaa sidii kabaal aan caadi ahayn gaar ahaan marka ay ciidamadu ka soo horjeedaan jir adag.
• Intaa waxaa dheer, C/S waxay u nugul tahay xumaanta taasoo ka dhigaysa mid aad ugu nugul dhaawacyada
• Carruurta yaryar, seedaha ayaa aad u jilicsan marka loo eego cabbirka madaxa oo aan u dhigmin
• Carruurta, dhaqdhaqaaqa buuxa ee dhaqdhaqaaqa wuxuu joogaa C2/3 sidaas darteed waxay ka dhigaysaa dhaawacyo aad ugu badan C/S sare iyo isgoyska craniocervical. Carruurta, SCIWORA waxa laga yaabaa inay ku dhacdo marka aanay jirin wax caddayn ah oo dillaac ah
• Dadka qaangaarka ah, dhaqdhaqaaqa dhaqdhaqaaqa ayaa jooga C5/6 sidaas darteed ka dhigaysa C/S hoose mid aad ugu nugul dhaawacyada gaar ahaan inta lagu jiro meelaha ugu sarreeya ee dabacsanaanta.
• Dhaawaca afka ilmo-galeenka waxaa loo kala saaraa iyadoo loo eegayo hababka dhaawaca (kala-soocidda Harris & Mirvis)

Dhaawaca Fududeynta: Xasillooni vs. Aan degganayn

• Flexion jeexjeexa ilmada (jabka ugu daran, aan degganayn)
• Wejiga laba geesoodka ah oo kala go'a (dhaawac daran w/o jab, aan degganayn)
• Subluxation anterior (oo ay suurtagal tahay in aan xasilloonayn) waxay noqon kartaa dhaawac aad u khafiif ah
• Clay Shoveller Fx (hoos u kaca C/S SP, deggan)
• Cadaadis fudud oo jeex ah (Fx ugu benign, deggan)
• Isku-duubni-wareejin oo leh kala-bax waji keliya ah
• Hel taariikh dhamaystiran
• Samee baaritaanka jirka oo uu ku jiro baaritaanka neerfaha
• Tixgeli shuruudaha NEXUS (National Raajo-raajo degdeg ah Daraasad ka faa'iidaysi)

Farsamooyinka Sawirka:

• Waxa uu ku bilaabmaa raajo-raajo gaar ahaan xaaladaha aan lahayn is-afgarad la taaban karo oo neerfaha ah
• Nadiifi aragtida dambe ee dhexdhexaadka ah marka hore
• Haddii raajada raajada ay tahay mid aan faa'iido lahayn laakiin ay suurtogal tahay inay sare u kacdo dhaawacyada daran iyo cillad maskaxeed oo jirta, CT scan w/o ka soo horjeeda ayaa loo baahan yahay
• Tixgeli baarista CT-ga ee bukaannada leh isbeddello hore u jiray: spondylosis hore, saxan, AS, RA, laf dhabarta qalliinka kadib, cilladaha ku dhasha (Klippel-Feil syndrome, iwm.)

Cadaadis toosan:

• Jefferson aka dillaacay Atlas Fx (aan degganayn gaar ahaan haddii seediga Transverse jeexan yahay, curyaanka xadhigga 20-30% kaliya)
• Waa maxay sababtu? Sababo la xiriira jajabka kala go'a iyo ballaarinta kanaalka
• Burst Fx of the Thoracic ama Laf-dhabarta Lumbar (aan degganayn, xudunta curyaannimada ayaa dhici karta)

Sida loo Qiimeeyo Sawir-qaadista Laf-dhabarka ee Kiisaska Dhaawaca:

• Ku dhis 5-xariiq oo ku yaal aragtida dambe
• Ogsoonow haddii wejiyadu ay si fiican isu toosan yihiin oo u siman yihiin
• Hubi summetry dhererka saxanka
• U fiirso sii balaadhinta ama sii wadida fogaanta isdhaafsan
• Si taxadar leh u baadh unugyada jilicsan ee prevertebral
• Qiimee mudada udhaxaysa ATlanto-dental (ADI)

• Xaaladaha dhaawac, qiimee oo cadee lateral dhexdhexaad ah marka hore
• Ha sameynin aragtiyo dabacsan ama fidsan xaaladaha degdega ah ka hor raajooyinka ama iskaanka CT-ga ayaa ka saaraya xasillooni darro weyn
• Fiiro gaar ah u yeelo unugyada jilicsan ee prevertebral
• Haddii uu ka dhumuc weyn yahay xadka caadiga ah, ka fiirso dhiigbax daran oo naxdin leh
• Asymmetry daahsoon iyo balaadhinta dhererka saxanka dambe iyo wejiyada leh faninta laf dhabarta waxay noqon kartaa sifo muhim ah oo jeexjeexan seedaha dambe

Dhaawacyada is-bedbeddelka (M/C Mechanism)

• In badan oo ka mid ah axial-hoosaadka C/S C-3-C7)
• Dhaawacyo aan xasilloonayn:
• Jebinta ilmada laablaaban (M/C C5 & C6) v. aan degganayn
• Tilmaamaha rad ee muhiimka ah:

• Jajabka hore ee jirka oo saddex xagal ah "jeexid" weyn
• Taageerida SP-yada, saxanka dambe iyo balaarinta wejiga taasoo muujinaysa jeexjeexa seedaha laf dhabarta ee waaweyn iyo xasillooni darro
• Isbeddelka dambe ee jabka jirka vertebral wuxuu soo jeedinayaa isku-duubnaanta xadhigga hore ee hore
• Burburinta unugyada jilicsan ee prevertebral>20-mm at C6-7
• 80% kiisaska waxaa laga yaabaa inay isla goobta ku curyaanaan ama ay yeeshaan curyaan weyn isla markiiba ka dib

Dhaawac Qoorta Ba'an. Waa maxay astaamaha shucaaca muhiimka ah? Waa maxay cilad-sheegiddu?

• CT scan w/o waxay ka soo horjeedaa dib u dhiska sagittal. Xusuusnow C7 Flexion jeexjeexyada ilmada Fx.
• CT waxaa laga yaabaa inay ku caawiso qeexid dheeraad ah iyo qorshaynta qalliinka ka hor
• Waxaa laga yaabaa inay raacdo sawirka MR iyo qiimaynta dhaawaca neerfaha

• Dareeraha xasaasiga ah (T2) jeex sagittal MRI ee jabka ilmada Flexion ee C4 iyo suurtogalnimada C5
• Ogsoonow nabarka calaamada sare ee xoogga leh ee xudunta iyo seedaha ku hareeraysan ee muujinaya bararka xuddunta iyo ischemia
• Maareynta: neurosurgical oo leh laf dhabarta
• Dhibaatooyinka:
• Quadriplegia/paraplegia
• Dhibaatooyinka neefsashada
• Naafada, isbeddelka tayada nolosha
• Cimrigii nolosha oo hoos u dhacay

• Kala-bax labada dhinac ah (aan degganayn)
• Mechanism: Dhaawaca leexleexinta
• Raadiyaha muhiimka ah: jirka hore ee barokacay 50% ama ka badan
• Wejiyada way kordheen oo qufulan (waxa lagu dhejin karaa sawirka bidix)
• Jeexitaanka weyn ee seedaha
• Fursadaha isku xidhka xudunta daran iyo curyaannimada
• Bukaanka qaba jilicsanaanta seedaha iyo isbeddellada xumaanta ayaa halis sare ugu jira
• Raajo raajo bilawga ah waa talaabada ugu horeysa

Iskaanka CT-ga iyo Isbarbardhigga waa Muhiim:

• Faahfaahin dheeraad ah oo ku saabsan dhaawacan
• Jabka wejiga, jabka miskaha
• Qorshaynta maamulka

Dareeraha sagittal ee xasaasiga ah MRI ee kala-baxa wajiga C5 ee laba geesoodka ah, dhaawaca xudunta ischaemic ee la qiyaasi karo, iyo dhaawacyada unugyada jilicsan ee dambe

• Maamulka:
• Raajo-raajo, ka dibna CT scan ka dibna isla markiiba la xidhay (tus. haddii bukaanku miyir qabo)
• Waxaa la socda kiisas aad u dhib badan MRI ka dibna daryeel qalliin
• Haddii bukaanku soo jeedo oo neerfayaashu deggan yihiin, CT iyo dhimista xiran ayaa ku filan
• Kiisaska adag iyo hoos u dhigista xiran ee guuldareystay waxay u baahan karaan xasilin qalliin
• Dhibaatooyinka: laf-dhabarka dhaawac iyo curyaan
• Laxity ligamentous oo daahday iyo xasillooni darro

• • Kala-baxa wejiga midaysan (dhaawac kala-rogid) oo ka daran kala-bax laba geesood ah
  • Inta badan la seego dhaawaca ilmo galeenka ee aan degganayn ee raajo
  • Astaamaha raadka muhiimka ah: jirka oo hore loo turjumay 25% waji ayaa u muuqda mid khaldan
  • Kiliinik ahaan waxa loo soo bandhigi karaa radiculopathy esp hal dhinac ah. C6 ama C7
  • Baaritaanka CT-ga ayaa loo baahan yahay si loo qiimeeyo jabka wejiga/cudurka kale
  • Qiimaynta ka hor dhimista iyo qorshaynta daryeelka
  • Maareynta: dhimista xiran esp. bukaan miyir qaba
  • Dhibaatooyinka: herniation-ka degdega ah ee disc herniation/retropulsion, laxity ligamentous, dhaawaca neerfaha

Habka Sawirka Dhaawaca lafdhabarta

khayraadka:

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