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辉煌娱乐国际快速充值中心 齿状突骨折III型
2020-01-11 11:51:07   浏览次数:2878次

辉煌娱乐国际快速充值中心 齿状突骨折III型

辉煌娱乐国际快速充值中心,来源:双语学影像;本期病例选自auntminnie.com

our appreciation is extended to dr. james chen, university of pennsylvania department of radiology, for contributing this case.

history and ct images

history

a 55-year-old intoxicated man status post motor vehicle accident. patient is combative in the trauma bay, limiting clinical examination.

55岁男性,醉酒后车祸伤。患者外伤后情绪激动,无法临床体检。

1.the appearance of the odontoid process most likely represents a congenital fusion defect.

患者齿状突先天性融合异常。

true

false

2.a fracture extends into the base of the c2 vertebral body.

骨折累及c2基底部。

true

false

3.there is severe spinal canal narrowing with probable cord impingement.

椎管重度狭窄伴脊髓损伤可能。

true

false

4.the fracture involves the left transverse foramen.

骨折累及左侧横突孔。

true

false

5.there is widening of the atlantodens interval.

寰齿间距增大。

true

false

6.which of the following is present in the above images?

以上各图中可见下列哪些征象?

atlantoaxial dissociation

寰枢椎脱位

odontoid process fracture

齿状突骨折

teardrop fracture

泪珠样骨折(枢椎椎体前下缘骨折)

chance fracture

chance骨折

diffuse lytic osseous metastases with pathologic fracture

弥漫性溶骨性转移瘤伴病理性骨折

additional questions

7.which is the appropriate classification of the above pathology based on the anderson and d’alonzo classification system?

根据anderson and d’alonzo分型,本例骨折属于哪一型?

type i

type ii

type iii

8.which of the following is the best next step in management?

下一步应如何处理?

ct angiography

mri

emergent cervical fusion

急诊颈椎融合术

cervical immobilization and follow-up ct in one week

颈椎固定,一周后ct复查

cta images

ct angiography (cta) is performed to assess for injury of the left vertebral artery.

9.the left vertebral artery is occluded.

左侧椎动脉闭塞。

true

false

10.there is slight luminal irregularity of the left vertebral artery adjacent to the c2 transverse foramen.

左侧椎动脉近c2横突孔处管腔略不规则。

true

false

11.which of the following types of dens fractures is most likely to be complicated by nonunion without surgical fusion?

如果不进行手术融合,哪一型齿状突骨折最易引起骨折不愈合而使病情复杂。

type i

type ii

type iii

选择题答案:

findings and diagnosis

ct of the cervical spine

ct images demonstrate a fracture through the base of the odontoid process extending into the left c2 body and involving the left transverse foramen. there is mild posterior displacement and superior distraction of the odontoid fracture fragment. there are no retropulsed fracture fragments within the spinal canal or evidence of significant associated spinal canal narrowing. there are multilevel spondylotic changes.

ct示齿状突至c2基底部骨折并累及左侧横突孔。齿状突骨折片向后上方略移位、分离。椎管无明显狭窄,内未见明显游离骨片。颈椎多个节段见退行性改变。

cta of the neck

cta was performed to evaluate the left vertebral artery given fracture involving the left transverse foramen. images demonstrate slight luminal irregularity in the left vertebral artery along its course through the left c2 transverse foramen, likely reflecting a small dissection. the vessel, however, remains patent.

由于骨折累及左侧横突孔,患者行cta以评价椎动脉情况。图像示左侧椎动脉约c2横突孔水平管腔稍不规则,但仍通畅。

differential diagnosis

odontoid process fracture 齿状突骨折

os odontoideum 齿状突小骨

pathologic fracture 病理性骨折

c1/c2 subluxation c1/c2半脱位

ossiculum terminale persistens 永存骨骺

diagnosis

type iii odontoid process fracture

齿状突骨折iii型

key points

anderson and d’alonzo分型

type i: approximately 8% of fractures, stable

约占全部骨折的8%,稳定性骨折

type ii: approximately 59% of fractures, always unstable

约占全部骨折的59%,多为非稳定性骨折

type iii: approximately 33% of fractures, variably unstable

约占全部骨折的33%,不稳定性骨折

来源:双鱼学影像

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