版權(quán)說(shuō)明:本文檔由用戶(hù)提供并上傳,收益歸屬內(nèi)容提供方,若內(nèi)容存在侵權(quán),請(qǐng)進(jìn)行舉報(bào)或認(rèn)領(lǐng)
文檔簡(jiǎn)介
1、Imaging of Thoracic and Lumbar Spine Fractures,Fractures of the thoracic and lumbar spine are common in patients who have sustained high-energy spinal trauma, and are associated with injury to the spinal cord in up to
2、 50% of cases .[1]Accurate early assessment is essential because delay in diagnosis may result in the development of neurologic complications. Clinical assessment of these patients is often challenging,and as a resul
3、t,diagnostic imaging usually plays a central role in our management.,1. Diaz JJ et al.Practice management guidelines for the screening of thoracolumbar spine fracture.Trauma 63:709-718,2007,The purpose of this slides is
4、to explore this role by answering the following 4 questions: (1) What are the imaging options? (2) Who should be imaged? (3) How should they be imaged? (4) What are the imaging findings for the
5、 most common types of thoracolumbar fractures?,1. What are the imaging options?,RadiographyRadiography is typically the first modality used to evaluate the thoracolumbar spine after trauma.In the thoracic sp
6、ine, anterposterior (AP) and lateral views are usuelly supplemented with a swimmer`s lateral view (y)In the lumbar region, AP and lateral views are typically sufficient.,,Arrowheads: left paratracheal stripeBlackarrow
7、: interdediculate distanceWhitehead: C7 vertebra,,Normal lumbar spine,,Computed TomographyThe advent of computed tomography (CT) has revolutionized spine imaging.This technique allows for very rapid scanning and resu
8、lts in the acquisition of a continuous dataset that can be used to create extremely thin axial slices as well as exquisite reconstructed images in any plane.,,An additional advantage of this technique is that data from C
9、T scan of the chest, abdomen,and pelvis obtained to evaluate for visceral injury can be uesd to simultaneously generate reconstructed images of the spine without the need for rescanning the patient.,,CT is clearly superi
10、or to radiographs for demonstrating fractures of the thoracolumbar spine with a sensitivity of 94%-100% compared with 33%-73% for radiographys. [2]CT is also more accurate than MRI for detecting factures,2. Berry GE e
11、t al:Are plain radiographys of the spine neccessaryduring evaluation after blunt trayma?Accuracy of screening torso CT in thoracic/lumbar spine fracture diagnosis.JTrauma 59:1410-1413,2005,,Analysis of images in all 3 st
12、andard planes is necessary.Additionally,images should be viewed using “bone” windows to detect osseous injuries as well as “soft tissue” windows to look for associated abnormalities such as a disc protrusion or epidural
13、hematoma.,,A : sagittal(midline) B : parasagittal C :coronal,,Magnetic Resonance ImagingWhile CT is best for detecting fratures, MRI is superior for demonstrating soft tissue pathology such as intrinsin cord injury
14、,ligament pathology,hematoma,or muscle tear. [3],3. Slucky AV:Using magnetic resonance imaging in spinal trauma:indications,techniques,and utility.J AM Acad orthop Surg 6:134-145,1998,,T1-weighted sequences provide a goo
15、d overall display of anatomy and are recognized by the low signal intensity of the cerebrospinal fluid on these images.T2-weighted imaging,which results in bright signal from fluid ,is best for detecting pathology beca
16、use of the increased fluid content in areas bone or soft tissue injury,,,,2. Who Should Be Imaged?,Delay in diagnosis of a thoracolumbar fracture may result in a higher incidence of neurologic complications. Thus highl
17、ighting the need for rapid and accurate assessement of these patients,and raising the important question of which patients with a history of spine trauma should undergo further investigation with diagnostic imaging?,,Not
18、 all patients with with a history of spine trauma should be evaluated with diagnostic imaging .There are a numerous criteria that are useful for determining which patients should undergo further diagnostic imaging . [4
19、],4. Hsu JM et al:thoracolumbar fracture in blunt trauma patients: guidelines for diagnosis and imaging.Injury 34:426-433,2003,,These include A high energy mechanism(fall from>10 ft (3m), ejection during a motor vehi
20、cleaccident, etc.)An altered level of consciousnessA major distrcting injuryA known fracture anywhere in the spine,3. How Should They Be Imaged?,Screening:Radiography or CT?Although screening the spine with CT is now
21、 recommended for patients who have a history of high-energy trauma,radiographys are probably adequate for those who have sustained a low-energy.If there is any suggestion of a fracture on radiographys,further evaluatio
22、n with CT is indicated,because of the known limitations of radiographys,,,,A comprehensive scan of the entire spine, chest, abdomen, pelvis can be obtained CT is now recommended as the screening modality of choice for
23、blunt trauma patients who are at high risk for spinal injury.,,MRIThe ability of MRI to directly display the cord,disc material,epidural hematoma,and ligaments makes it a powerful complementary modality to CT.Thus MRI
24、 should be reserverd for the patient who has a neurologic deficit ,ligamentous injury,and high suspicion of injury in radiography or CT studies.,Imaging Findings,Normal AnatomyRadiographysVertebral alignment should als
25、o be assessed on the AP view along with the interpediculate distance (the distance between the inner margins of the pedicles).,,The distance between the pedicles normally decreases from the level of T1 through T6 and the
26、n increases gradually from T6 through L5. Paraspinal soft tissue “stripes” are also visible on the AP film of the thoracic spine with the stripe on the left normally wider than that on the right owing to the presence of
27、 the descending aorta in that region,,CTOsseous anatomy should be evaluated using a “bone window” display that provides for optimal assessment of cortical and trabecular detail. sagittal images are most useful for asses
28、sing vertebral and facet alignment. Similarly, soft tissue structures should be evaluated using a dedicated “soft tissue” display. allowing for detection of epidural hematoma or a trauma-related disc protrusion,,B: epid
29、ural hematoma that with relative high density,,MRIvertebral elements are of predominantly high signal intensity on T1-weighted images. The spinal cord is of intermediate signal (similar to skeletal muscle) on all puls
30、e sequences, whereas the surrounding cerebrospinal ?uid will appear dark on T1-weighted images and very bright on T2-weighted images,,A normal intervertebral disc appears gray on a T1-weighted sequence, but shows differe
31、ntiation between the high signal nucleus pulposis and lowsignal annulus ?brosis on T2 or STIR images.,,Thoracolumbar FracturesGeneral CommentsThe type of injury that occurs with blunt trauma to the spine is related to
32、the forces acting upon it at the moment of injury and may involve ?exion, extension, compression, distraction, rotation, or shear forces. In general, pure compressive or distractive forces tend to produce fractures, whe
33、reas rotatory and shear forces often result in dislocations.,,Most injuries of the thoracic and lumbar spine occur near the thoracolumbar junction for a variety of reasons: (1) the ribcage provides additional stabi
34、lity for the ?rst 9 thoracic vertebrae (2)motion is greatest in this region of the thoracolumbar spine; (3) the facet joints transition from a predominantly coronal orientation in the upper thoracic spine to a
35、 more sagittal orientation in the lumbar spine, resulting in less resistance to ?exion in the lower thoracic and lumbar regions.,,Thoracic spine injuries above the thoracolumbar junction are less common, but have a high
36、incidence of associated neurologic injury. (2 reasons),,Classi?cation SystemsIn 1984, Denis proposed a 3-column classi?cation system for thoracolumbar injuries.,,Thoracolumbar fractures were also divided into “minor” an
37、d “major” groups. Minor fractures included those involving the spinous process, transverse process, and pars intra-articularis. Major fractures were broken into 4 categories: compression, burst, ?exion-distracti
38、on, and fracture dislocation.,,Fracture Types1. Compression Fracture On MR images, in addition to anterior wedging, an acute compression fracture will indicate edema-like signal intensity within the marrow of the a
39、ffected vertebral body. This is most conspicuous on a T2-weighted image. The absence of this type of signal within a compressed vertebra indicates an old, healed fracture.,,A(T1):2 thoracic fracturesB(T2):pronounced
40、 edema relative to the more proximal fracture,,As a result, MRI can be useful in differentiating acute from chronic injuries,,2. Burst Fracture Involves the middle column (posterior vertebral cortex) in addition to
41、the anterior and sometimes posterior columns as well,,,,,,3. Flexion–Distraction (Chance Fracture) This type of fracture was found to be associated the use of a lap seat belt.,,,,,,,,,,,,,,,4. Fracture–Dislocation
42、 Fracture–dislocation injuries are usually the result of compression and/or distraction forces combined with some degree of shear or rotation. These severe injuries are extremely unstable because they result i
43、n failure of all 3 columns, and are associated with the highest inci- dence of complete neurologic injury of any of the thoraco- lumbar injury patterns..,Conclusions,Although radiographs may be used to evaluate some pati
44、ents after blunt trauma, their ability to detect thoracolumbar fractures is limited, and CT is recommended for optimal assessment of those patients with a high-energy mechanism of injury. CT scans of the chest, abdomen
45、, and pelvis obtained for visceral injury, without the need for additional scanning, thereby saving time and radiation exposure.,,Although CT scanning provides an accurate assessment of canal compromise, there is no cons
46、istent association between canal narrowing and neurologic outcome. In addition to demonstrating any site and degree of cord compression, MRI is able to directly display the level and extent of intrinsic cord injury, an
47、d provide some prognostic information based on the severity of the cord ?ndings.,Thanks for your attention!,Backdrops:- These are full sized backdrops, just scale them up!- Can be Copy-Pasted out of Templates for use a
溫馨提示
- 1. 本站所有資源如無(wú)特殊說(shuō)明,都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請(qǐng)下載最新的WinRAR軟件解壓。
- 2. 本站的文檔不包含任何第三方提供的附件圖紙等,如果需要附件,請(qǐng)聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶(hù)所有。
- 3. 本站RAR壓縮包中若帶圖紙,網(wǎng)頁(yè)內(nèi)容里面會(huì)有圖紙預(yù)覽,若沒(méi)有圖紙預(yù)覽就沒(méi)有圖紙。
- 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
- 5. 眾賞文庫(kù)僅提供信息存儲(chǔ)空間,僅對(duì)用戶(hù)上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理,對(duì)用戶(hù)上傳分享的文檔內(nèi)容本身不做任何修改或編輯,并不能對(duì)任何下載內(nèi)容負(fù)責(zé)。
- 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容,請(qǐng)與我們聯(lián)系,我們立即糾正。
- 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時(shí)也不承擔(dān)用戶(hù)因使用這些下載資源對(duì)自己和他人造成任何形式的傷害或損失。
最新文檔
- 胸腰椎骨折
- 胸腰椎骨折的治療
- 胸腰椎骨折病人護(hù)理
- 胸腰椎骨折教學(xué)查房
- 胸腰椎骨折手術(shù)課件
- 胸腰椎骨折病人的護(hù)理
- 胸腰椎骨折的研究.pdf
- 胸腰椎骨折后縱韌帶損傷的臨床及影像學(xué)研究.pdf
- 胸腰椎骨折診斷治療講解
- 胸腰椎骨折護(hù)理查房
- aospine胸腰椎骨折分類(lèi)系統(tǒng)
- 早期活動(dòng)對(duì)胸腰椎骨折術(shù)后患者影像學(xué)療效的影響.pdf
- 胸腰椎骨折的精準(zhǔn)微創(chuàng)治療
- 胸腰椎骨折的研究進(jìn)展.pdf
- 胸腰椎骨折的精準(zhǔn)微創(chuàng)治療
- 胸腰椎骨折合并截癱的術(shù)后護(hù)理
- 胸腰椎骨折并截癱黃呈成
- 胸腰椎骨折的微創(chuàng)手術(shù)治療講解
- 胸腰椎骨折經(jīng)椎弓根固定釘骨界面影像及組織學(xué)改變.pdf
- 胸腰椎骨折內(nèi)固定術(shù)的護(hù)理配合
評(píng)論
0/150
提交評(píng)論