广州第一人民医院温世锋主任医生的颈椎骨折病例研究报告

张口位形态
枕骨大孔
Odontoid View
• An adequate film should include the entire odontoid and the lateral borders of C1-C2. Occipital condyles should line up with the lateral masses and superior articular facet of C1. The distance from the dens to the lateral masses of C1 should be equal bilaterally. The tips of lateral mass of C1 should line up with the lateral margins of the superior articular facet of C2. The odontoid should have uninterrupted cortical margins blending with the body of C2. •
Incidence
• 10 - 15 per million • 18 - 35 years • Male - 3:1 • RTA 51% - cars • Domestic 16% • Industrial 11% • Sports 16% - diving incidents • Self harm 5%
Level of Spinal injury
• Neurological level is at the most lowest segment with normal motor & sensory function • Difficult to determine : - as most muscle efferents receive fibres from more than one level - Closed cord lesions may extend over several cms. - Dermatomes have imprecise boundaries.
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Alignment
Key Things to Identify
• Predental space – should be 3mm or less
Key Things to Identify
• Disc spaces should be the equal and symmetric
Key Things to Identify
Significance
• Unstable if middle column + either Anterior or Posterior column is damaged • Rupture of interspinous ligament is : - associated with avulsion of spinous process - Unstable spine - Further flexion increases neurological injury
AP View
• The height of the cervical vertebral bodies should be approximately equal The height of each joint space should be roughly equal at all levels. Spinous process should be in midline and in good alignment.
C1 C2
AtlantoAxial Anatomy
Facet for Occipital Condyle
Transverse Ligament
（ 4）
Cervical Spine 1 and 2
颈椎上段矢状面
环枕前膜
覆膜 ？ ？
前纵韧带
后纵韧带
Plain Films
• • •
AP, lateral, obliques open mouth Swimmer's view
Axis Fractures
• Incidence: 6% of cervical spine fractures • Associated with atlas fractures in 8% • Hyperextension • Often forward subluxation of C1 on C2 Odontoid fracture • Type I • Avulsion of tip of odontoid (5-8%) • Difficult to detect; required CT • Type II • Fracture through base of dens (54-67%) • Complication: nonunion • Type III • Subdental injury (30-33%) • Prognosis: good
• Prevertebral soft tissue
– – May be due to hematoma from a fracture Soft tissue swelling may make fx dx difficulty
Upper limits of prevertebral soft tissue level of C1: 10 mm level of C4: 7 mm level of C6-7: 20 mm
1、颈椎的特征
（1）、椎体小、有横突孔、棘突分叉、上下关节突近似水平位、椎孔 较大且多呈卵圆形。 （2）、钩椎关节（Luschka’s 关节） （3）、UTAC---即Unco、Transero、Articular complex称钩突、横 突、关节突复合体。
颈椎上面观
棘突 椎孔 上关节面 横突孔 钩突 椎体
Cord level
• • • • • • C2 – C7 = add +1 for cord level T1 – T6 = add +2 T7 – T9 = add +3 T10 = L1, L2 level T11 = L3, L4 level L1 = sacro coccygeal segments
Types
• • • • • Cervical 40% Thoracic 10% Lumbar 3% Dorso lumbar 35% Any 14%
Cervical spine anatomy
• Anterior column - Anterior longitudinal ligament+ Anterior annular ligament and anterior half of VB. • Middle column – Posterior long. Lig. + Posterior annular ligament +Posterior half of VB. • Posterior Column – Lig flavum + superior & Interspinous lig + intertransverse capsular lig + neural arch + pedicle & spinous process.
颈椎骨折
Cervical spine injury
广州市第一人民医院脊柱外科
Spine surgery department, Guangzhou 1st municiple people,s hospital
温世锋 医生
Dr.WEN Shi-feng
Outline
• • • • • • Incidence Types Clinical signs Radiological signs Spinal shock Management
Umbilicus Inguinal crease Medial thigh Medial calf Lateral calf Lateral foot Perianal
Spinal Level Muscle Innervation
C3, C4 C4 C5, C6 C7 C8 T1 T1- T12 Trapezius Diaphragm Biceps Triceps Shoulder Elevation Respiration Forearm flexion Forearm extension
Skeletal Trauma
Jefferson Fracture
• Compression fracture of the bony ring of C1, characterized by lateral masses splitting and transverse ligament tear. Best seen on odontoid view Signs: Displacement of the lateral masses of vertebrae C1 beyond the margins of the body of vertebra C2. CT is required to define the extent of fracture • •
颈椎前面观
上关节突
钩突 下关节突 椎体
颈椎左侧面观
上关节突
下关节突 棘突
环椎、枢椎
(1)
上面观
前面观
环椎、枢椎
(2)
下面观
后面观
Anatomy Review
Sites of transverse ligaments
上位颈椎
后面观