Habka Sawirka Dhaawaca laf-dhabarka ee lagu ogaanayo Qaybta II

Dhaawaca Dheeraadka

• Hangman's Fx aka traumatic spondylolisthesis ee C2 oo leh dillaac ka mid ah pars interarticularis ama pedicles (aan degganayn)
• MVA waa sababta ugu badan
• Mechanism: hyperextension ba'an ee C/S sare oo la mid ah suldaanka garsoorka (waligiis lama arkin, badi dhimashaduna waxaa sabab u ah neefta)
• Dabacsanaanta dugsiga sare waxay jeexjeexi kartaa PLL iyo saxanka
• Dhaawacyada xiriirka la leh: 30% waxay leeyihiin c-spine fx kale gaar ahaan ilmada ilmada ee C2 ama C3 sababtoo ah avulsion by ALL
• Curyaanka xadhkaha ayaa laga yaabaa inuu yimaado kaliya 25% sababtoo ah kala go'aan jajabyada lafaha iyo ballaarinta kanaalka

• Hangman fx iyo ilmada kordhinta
• Xumaanta afka ilmagaleenka iyo isku-duubnidii hore waa arrin muhim ah oo keeni karta dhaq-dhaqaaq la'aanta iyo jilicsanaanta, taas oo ka dhigaysa C/S mid sahlan inuu jabo
• Sawirka: raajada hore ee CT-ga ka dibna CT taas oo ka caawisa in la kala saaro dhaawac kale sida facet/pedicle Fx dheeraad ah. MRI waxaa laga yaabaa inay ku caawiso haddii ay ku adkaato dhaawaca Vertebral A
• Maareynta: haddii dhaawaca nooca 1 ka dibna la xiro hoos u dhigista iyo koolada adag ee toddobaadyada 4-6, halo bracing haddii nooca 2 (> 3-5mm barokaca) Fx / xasillooni darro, fiyuuska hore ama dambe ee laf-dhabarka ee C2-3 haddii nooca 3 Fx (> 5) -mm barokac)

 

 

• Ilmo-dheeraynta Fx (xasilloon) oo suurtogal ah in aan degganayn haddii la kordhiyo
• Kacsiga jirka hore ee hoose ee DHAMMAAN. In badan oo lagu arko dadka waayeelka ah ee qaba C/S spondylosis oo sarreeya
• Raadiyaha muhiimka ah: gees yar oo hore-hooseeya oo jirka ah, ma jiro wax carqalad ah oo ku saabsan toosinta ligamentous. Caadi ahaan marka la joogo C2 ama C3 sababtoo ah kacsanaan degdeg ah iyo ALL avulsion
• Dhibaato: Xuddunta xudunta dhexe (m/c dhaawaca xudunta aan dhamaystirnayn) esp. spondylosis oo sarreeya iyo stenosis kanaalka oo ay sababto laxity flavum ligamentum iyo osteophytes
• Maareynta: go'doomin adag oo adag

 

 

Dhaawaca Cadaadiska Toosan (axial).

• Jefferson Fx (oo lagu magacaabo dhakhtarka neerfaha ee Britishka oo qeexay) (aan degganayn laakiin neerfayaasha aan fiicneyn Fx) 7% dhammaan dhaawacyada C / S. Xasiloonidu waxay ku xidhan tahay haddii seedaha udub-dhexaadku ay taam yihiin ama jeexan yihiin, taas oo lagu ogaan karo kor u kaca miisaanka C1 ee ka sarreeya C2> 5-mm oo la isku daray (sawirka bidix)
• Farsamaynta: C1 cadaadis (tusaale, quusitaanka biyaha gacmeed) taasoo keenaysa dilaac Fx-classically 4-qaybood ee hore iyo dambe ee C1. Kala duwanaansho ayaa jira.
• Dhibaatooyinka: 50% waxay muujinayaan C/S Fx kale, 40% waxay muujinayaan Odontoid C2 Fx esp. haddii kordhin iyo axial loading dhacaan

 

 

• Sawirka: raajo raajo oo ay ku xigto CT scan si loo qiimeeyo dhaawaca subaxial iyo kakanaanta dhaawaca C1. Ogsoonow Jefferson Fx oo leh tiir iyo foramina fx transverse oo u baahan fiyuuska dambe ee indhaha-ilma galeenka (sawirka midig ee hoose).
• Maareynta: Dhaqdhaqaaq-la'aan qallafsan oo qallafsan haddii seedaha ka gudubtay ay taam tahay. Isku-xidhka Halo ama fiyuuska haddii seedaha gudubta ay dillaacdo

 

 

Dhaawacyada ilmo-galeenka oo leh habab kala duwan oo dhaawac ah

• Jajabka habka Odontoid:
• Kuwani waxay ku dhacaan habab kala duwan, dabacsanaan, fidin, dabacsanaan lateral. Dadka da'da ah ee qaba spondylosis oo sarreeya ayaa halis sare ugu jira.
• Kala soocidda Anderson & D'Alonzo (hoos). Nooca 2 waa kan ugu caansan uguna xasilloon. Nooca 3 ayaa leh fursada ugu wanaagsan ee lagu bogsiin karo d/t dhiigbax aad u weyn oo galay jidhka C2 iyo bogsiin ka fiican.
• Sawirka: raajada raajo waxay waayi kartaa xoogaa Fx ah. Iskaanka CT waa lama huraan.
• On raajada qoraalka u janjeedha Dens ee lateral iyo aragtida APOM. CT ayaa muujin doonta dhaawaca oo kala saari doona.
• Dhibaatooyinka: dhaawaca xadhigga, urur la'aanta

 

 

• CT scanning: nooca 2 odontoid jab (aan degganayn)
• Maareynta: Nooca 1 (Alar ligament Avulsion) aadka u xasiloon
• Bukaannada da'da yar, brace Halo waxaa loo isticmaalaa in lagu daweeyo nooca 2
• Bukaannada waaweyn uma dulqaadanayaan Halo
• Fiyuuska C1-2 ee shaqaynaya haddii Dx aanu degganayn iyo calaamadaha xadhigga ama arrimo kale oo murugsan ayaa jira

 

 

Kala duwanaanshaha shucaaca caadiga ah & cilladaha la midka ah Pathology

• Dhakhaatiirta dhabarta u muuqda si ka duwan gaar ahaan gudaha carruurta ka yar 10-sano.
• Kala duwanaanshaha caadiga ah; ADI 5-mm waxaana laga yaabaa inay kordhiso ama hoos u dhigto aragtiyaha dabacsan/dheeraaday 1-2-mm
• C2-3 waxaa laga yaabaa inay u muuqato sida been-subluxation sababtoo ah caajisnimada caadiga ah ee ligamentous ee carruurta (falaarta hoose)
• Jidhka vertebral ee carruurta sida caadiga ah waa ka sii dhuuban yihiin oo hore ayaa loo lalmaa sababtoo ah joogitaanka unugyada cartilaginous

• Aragtida APOM waxay u muuqataa mid ka duwan carruurta, iyo qaar ka mid ah asymmetry ee cufnaanta articular C1 waa caadi (sawirka sare ka hooseeya) waana inaan lagu khaldin Jefferson Fx
• Dadka qaangaarka ah, wax kasta oo asymmetry ah ama "kordhinta" ee cufnaanta articular C1 waa cudur-daawasho waxayna muujin kartaa Jefferson fx

 

 

• Xarumaha ossification caadiga ah ee Atlas synchondrosis ee carruurta waa in aan lagu khaldin jabka

 

 

• Terminalka ossiculum ee joogtada ah ee Bergman waa kala duwanaansho caadi ah / cillad aan caadi ahayn oo xarun ossification aan midaysnayn waana in aan lagu khaldin nooca odontoid fx

• Os odontoideum
• Xarun korriin aan midaysnayn oo hadda loo arko dhaawac aan la dareemin oo khalkhal galiyay koritaanka caadiga ah ee ilmaha ka yar 5-sano
• Waxa laga yaabaa inay sababto xasillooni darrada C1-2 waana in lagu qiimeeyaa dabacsanaan iyo aragtiyo afka ilmagaleenka oo la fidiyay.
• Waa in aan lagu khaldin nooca 2 Dens jabka sababtoo ah waxay si ka badan u muujinaysaa macdanta lafaha

 

 

• Agenesis laba-geesoodka ah oo aan dhammaystirnayn ee qaansada dambe ee C1
• Xiritaanka qarsoodiga ah ee qaansada dambe ee C1
• Waa inaan lagu wareerin jab
• Si kastaba ha ahaatee, calaamadaha gudaha ama xudunta ayaa laga yaabaa inay soo baxaan ka dib dhaawacmo xaaladaha qaarkood
• Xaalad aan caadi ahayn oo dhif ah ayaa soo koraysa sababtoo ah chondrogenesis-ka fashilantay iyo ossification ee xarumaha ossification ee dambe ee Atlas

 

 

• Bukaanka qaba cilladda Down syndrome-ka waxaa laga yaabaa inay la ildaran yihiin laxity ligamentous oo kordhay iyo cillado kale oo aan caadi ahayn
• Khatarta sii kordheysa ee subluxation ee C1-2

 

 

• Burst Fx (aan xasiloonayn) 2-column waa dhaawac
• hab: loading axial oo leh dabacsanaan joogta ah ka dib dhicitaannada iyo MVAs
• Gobolka thoracolumbar ayaa ah midka ugu nugul sababtoo ah kor u kaca dhaqdhaqaaqa dhaqdhaqaaqa
• Shucaaca muhiimka ah: jabka jabka degdega ah iyo burburka dhererka jidhka, dib u soo noqoshada jidhka danbe iyo qallooc ba'an oo kyphotic ah oo ku saabsan aragtida dambe
• Dhanka hore ee muuqaalka: fidinta dhexda ah (hoos falaarta jaalaha ah), bararka unugyada jilicsan ee gobolka ( falaarta cagaaran ka hooseeya)

 

 

• Sawirka: raajada raajo waa in ay raacdo CT scanning w/o ka soo horjeeda
• MRI haddii neerfis ahaan aan degganayn sababtoo ah dhaawaca xuddunta ama xuddunta
• Dhibaatooyinka: Xumaynta xuddunta ee jabka lafaha si degdeg ah u soo laabtay
• Maareynta: aan qalliin ahayn haddii neerfayaashu ay saxan yihiin iyo <50% jirka oo dib loogu soo celiyo kyphosis ugu yar
• Hawl-fulin (fiyuus) haddii 50% ama ka badan oo jirka dib loo rogo, laminar/pedic Fx, neuro compromised

 

 

Dumar 18 Jir ah Ka Dib Shil Trampoline

• AP & muuqaalada L/S
• Ogsoonow jabka jabka degdega ah ee cadaadiska, jirka laf dhabarta oo ku fidsan curiyayaasha danbe
• Fidinta masaafada u dhexeysa T11-T12 (falaarta hoose)
• Khadka jaban ee Radiolucent waxaa lagu arkaa jirka T12 ee saadaasha AP
• CT scan ayaa la sameeyay

 

 

• Sagittal waxay dib u dhistay jeexjeexyada Thoracic iyo Lumbar CT ee daaqada lafaha
• Ogsoonow jabka jabka degdega ah, jidhka T12 oo ku fidsan xuubka iyo laminka
• Dx: Fursada jab ee T12
• Sawirka MR ayaa la sameeyay

 

 

• T2 Wl sagittal MRI
• Natiijooyinka: jabka jabka degdega ah ee jirka T12 oo ku fidsan walxaha dambe ee keenaya rayrayn ee seedaha dhexda iyo flavum
• Isku-buufin khafiif ah ee xadhigga fog ee ka sarreeya kooniska ayaa lagu xusay calaamad aan caadi ahayn
• Dx: Fursad jab

 

 

• Fursad Fx aka (Seatbelt Fx) - waa dhaawac leexleexan (aan degganayn)
• M/C ee lumbar hoose ee laabta-sare
• Dhammaan 3-da tiir way guuldarraystaan: tiirka 3 waxaa jeexjeexay kala-jeedin, tiirarka 1 iyo 2 waxay ku guul-darraystaan ​​isku-buufinta (Denis classification)
• Sababaha: MVA, dhicis
• Sawirka: raajada bilowga ah waa in la raacaa CT scanning w/o liddi ku ah si loo qiimeeyo jajabka lafaha retropulsion/cadaynta kanaalka. MRI waxa laga yaabaa inay caawiso si loo qiimeeyo dhaawaca xadhigga iman kara iyo jeexjeexa seedaha
• Maareynta: Dhaqdhaqaaq la'aan aan qalliin lahayn haddii neuro-ku xiran yahay
• Kala-bax hawleed iyo isku-duubnaan

 

 

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