Soo koobida Astaamaha Cudurada Kala Duwan ee Laf dhabarta

Laf-dhabarta discitis waxay ka dhigan tahay 2% ilaa 7% dhammaan caabuqyada muruqyada ee ay keento bakteeriyada, fungi, iyo, marar dhif ah, dulin. Qiyaastii kala badh dhammaan kiisaska caabuqa laf-dhabarka waxay ku yaalaan laf-dhabarka lumbar, wax yar ka badan saddex-meelood meel laf dhabarta, iyo inta soo hartay ee laf-dhabarka ilmo-galeenka.

Caabuqa xuubka

Discitis laf-dhabarka xuubka leh (PS) waxaa badanaa sababa caabuq hematogen ahaan faafiya, iyadoo Staphylococcus aureus uu yahay cudur-sidaha ugu badan, oo inta badan ku lug leh laf-dhabarka lumbar, iyo raajada oo aan lahayn gaar gaar ah iyo dareenka marxaladaha hore ee cudurka. MRI ee la xoojiyay waa habka doorashada ee baaritaanka hore ee caabuqyada laf-dhabarka; MRI waxay muujisaa bararka dhuuxa lafta iyo kor u qaadista xubnaha vertebral, saxannada intervertebral, booska epidural'ka, iyo/ama ku hareeraysan unugyo jilicsan oo leh ama aan lahayn xuubka naasaha oo ku yaal meel u dhow xuubka vertebral.

Fiiro gaar ah: (a) Shucaaca laf-dhabarka ee lumbar ee muujinaya L4 -L3 dhumucda dhererka dhererka iyo burburinta dusha sare ee L4 (falaarta). 

(b) Silbashka dambe ee khafiifka ah ee L3. Burburinta saxanka L3 - L4 oo leh isbeddello nasasho leh oo ku yimaadda tabeelaha ku xiga (Falaaraha). 

(c) sawirka Magnetic resonance (MR) oo muujinaya isbedelada naxsiga ah ee ku dhaca xuubka vertebral-ka iyo calaamadda aan caadiga ahayn ee dhuuxa vertebral ee ku xiga ( falaarta). Unugyada jilicsan ee prevertebral ayaa si muuqata u bararsan waxayna leeyihiin isbeddello barar ah. 

(d) Sagittal t1 ka dib duritaanka isbarbardhiga faleebada ayaa tusinaysa calaamada la xoojiyey ee dhuuxa lafta (asterisk), calaamada la xoojiyay ee booska epidural'ka iyo unug jilicsan oo prevertebral ah. U fiirso galitaanka kanaalka dhexe ( falaarta).

Qaaxada lafdhabarta

Qaaxada laf-dhabarta (TS), caabuqa laf-dhabarka ee granulomatous-ka ugu badan ee aan purulent ahayn oo uu keeno qaaxada Mycobacterium Gram-positive, iyo astaamaha sawirka ee ka sooca TS-ga PS ayaa lagu muujiyey shaxda hoose:

Shucaaca dambe ayaa muujinaya burburka lafaha, hoos u dhaca dhererka saxanka iyo nudaha jilicsan ee nudaha jilicsan oo leh ama aan lahayn xisaabin unugyada jilicsan ee ku hareeraysan.

On MRI, T1 caadiga ah xoojinta calaamadaha hooseeya iyo calaamadaha sare ee calaamadaha dareeraha-xasaasiga ah waxay ku lug leeyihiin jirka hore ee vertebral waxaana laga yaabaa inuu ku sii socdo dariiqa hoose ee lafdhabarta kale, guud ahaan iyada oo aan ku lug lahayn saxanka.

Xusuusin: 65-sano jir lab ah oo leh (a) axial iyo (b) qanjidhada lumbar (asterisks) oo leh kor u qaadida septal iyo darbiga (Falaaraha cad) .L3 ilaa S1 kor u qaadida jirka vertebral. Saxanka intervertebral oo burburay iyada oo aan lahayn kor u qaadis la taaban karo. Cadaadiska sac-dural (falaar cad). (c) ct sawirka dib u dhiska ee L3 ilaa S1 burburka jirka laf dhabarta.

Caabuqa Brucella

Brucellosis waa zoonosis endemic caalami ah oo uu keeno bacillus garaam-negative ah. Waxay badanaa ku lug leedahay laf-dhabarka lumbar, gaar ahaan L4.

Cudurku wuxuu ka bilaabmaa qaybta hore ee jidhka laf dhabarta ee saxanka intervertebral waxana laga yaabaa inuu waxyeeleeyo kala-goysyada yaryar. Nabarada Paravertebral waxay ku dhacdaa si ka yar si isdaba joog ah waxayna ka yar yihiin cabbirka TS. Anatomy-ka laf-dhabarta ayaa weli ah mid sugan.

Fiiro gaar ah: caabuqa Brucella lumborum, radiographs waxay muujinayaan sclerosis ee laf-dhabarka lumbar, silbashada hore ee laf-dhabarka lumbar, burbur aan caadi ahayn oo u eg heerka hore ee jidhka vertebral, iyo samaynta cribriforms lafaha ee dhinaca hore ee jidhka vertebral.

Caabuqyada fungal

Caabuqyada laf-dhabarka fangas (FS) waa naadir waxaana inta badan lagu arkaa bukaannada difaaca jirka. Fungi badan ayaa suurtagal ah inay ku lug yeeshaan, oo ay ku jiraan Pseudomonas, Aspergillus, Bacillus, iyo Coccidioides. Laf-dhabarta dhuunta waa goobta ugu badan, oo la mid ah TS, habka caabuqa wuxuu ka bilaabmaa qaybta hore ee laf dhabarta waxayna mararka qaarkood ku fidi kartaa laf dhabarta aan ku xiganayn.

Fiiro gaar ah: sawirka sagittal ee CT scan ee bukaanka qaba coccidioidomycosis. Nabaro lafaha xaddidan oo aan lahayn xuubka sclerotic ayaa ah mid ka mid ah cudur-sidahaan soo bandhigida. Burburka ballaaran ee T1 wuxuu keenaa burburka vertebral. Inkasta oo dhaawaca lafaha ballaaran uu jiro, booska C7-T1 ee intervertebral ayaa la ilaaliyay, isbeddel sifo ah oo ku yimaada coccidioidomycosis (guddiga saxda ah) Sagittal MRT2WI ee isla bukaanku wuxuu xaqiijinayaa ilaalinta bisha booska intervertebral C7-T1, oo leh calaamad muhiim ah oo T2 ah oo muujinaysa ka-qaybgalka hore ee C6-C7 discs. Dhaawaca lafaha ayaa ku fiday dhinaca hore ee lafaha hoose ee jidhka vertebral, taasoo keentay infakshanka unugyada jilicsan ee hore ee IV. Isbeddellada infekshanku waxay ku faafaan heerar kala duwan, iyagoo si fudud u aqoonsanaya habka faafinta nooca subligamentous, taas oo u horseedi karta dhaawacyo badan oo heerar ah oo aan isku xigin.

Spondylitis ankylosing

Ankylosing spondylitis (AS) waa cudur bararka difaaca jirka oo daba-dheeraaday kaasoo ugu horreyn saameeya laf-dhabarka wuxuuna u horseedi karaa xanuun daran oo daba-dheeraada oo ka yimaada isku-dhafka laf-dhabarka.

Dhibaatada kale ee bukaanada qaba AS waa horumarinta cudurka disc ee xaddidan, iyo sawir-qaadista, AL waxaa laga sooci karaa spondylitis bararka cilladaha xudunta ah ee hal ama laba laf dhabarta, cidhiidhiga booska saxanka, iyo meelaha sclerosis reactive ee ku wareegsan cilladaha osteolytic.

Fiiro gaar ah: Bukaanka qaba ankylosing spondylitis, 44 jir lab ah oo qaba xanuunka dhabarka hoose ee joogtada ah iyo dhaqdhaqaaqa xaddidan. Sagittal ct of (a) thoracic iyo (b) daaqadaha laf-dhabarka lumbar waxay muujinayaan fidinta ligamentous syndesmosis oo ay weheliyaan ligamentiga dheer ee hore ( fallaadho ). Waxa kale oo jira ossification iyo fusion of seedaha interspinous lumbar (Falaaraha la muujiyay). (c) Sawirka wadnaha ee heerka laf-dhabarka lumbar wuxuu muujinayaa isku-dhafka qaybaha dambe iyo kala-goysyada synovial articular (falaaraha).

Cudurka Osteomyelitis Syndrome

Soo gaabinta SAPHO waxaa loola jeedaa isku-dhafka murqaha iyo maqaarka maqaarka (synovitis, finan, pustulosis, osteomalacia, iyo osteomyelitis), oo leh darbiga hore ee xididdada (oo ay ku jiraan kala-goysyada sternoclavicular, kala-goysyada costothoracic, iyo sternoacetabular suxulka laf dhabarta, oo ay raacaan inta badan xubnaha suxulka laf dhabarta). muujinta shucaaca raajada waa osteolysis jirka laf-dhabarta oo leh ama aan lahayn burbur, iyo sidoo kale osteomalacia iyo ossification paraspinal.MRI waa sawirka ugu xasaasisan MRI waa habka sawir-qaadista ee ugu xasaasisan, iyo muujintiisa ugu muhiimsan waxaa ka mid ah isbeddelka fidsan ama focal vertebral calaamadaha isbeddellada dareeraha xasaasiga ah ee isdaba-joogga ah ee nabaad-guurka ee is-goysyada is-goysyada bararka hore, iyo bararka nudaha jilicsan.

Fiiro gaar ah: 62 jir lab ah oo qaba xanuunka SAPHO. (a) Sagittal t2-miisaan iyo (b) sawiro la xisaabiyay (CT) waxay muujinayaan ossification ee seedaha dhaadheer ee hore (Falaaraha madow) Ma jiraan wax aan caadi ahayn oo aan caadi ahayn oo saxan ama dareeraha paravertebral. L1 si weyn ayaa dib loogu dhigay ka dib jabkii hore ee cadaadisku. (c) Axial CT waxay muujinaysaa ankylosis ee wadajirka costovertebral saxda ah (asterisk). (d) Dib-u-dhiska wadnaha wadnaha ee CT wuxuu muujinayaa laba-geesoodka feeraha laabta laabta ee clavicle ankylosis (xiddigaha madow). (e) Sawirka lafaha oo muujinaya kor u qaadista raadiyahatracer ee labada kala goysyada ee ay saameysay (xiddigaha cad).

Spondyloarthropathy sifeynta la xiriirta

Spondyloarthropathy-la-xidhiidha sifeynta (DRS) waa isbeddel ku yimaada bukaan-socodka hemodialysis ee muddada dheer. Waxay ku badan tahay laf-dhabarka ilmo-galeenka waxayna caadi ahaan soo bandhigtaa cidhiidhiga booska intervertebral, burburinta daboolka dhamaadka, la'aanta sclerosis, samaynta lafo cusub, caabuqyada paraspinal / mareenka, iyo xoojinta booska.

Fiiro gaar ah: Lafo-jileec ballaaran oo lafaha lumbar iyo miskaha sacral. Burburinta cirifka anterosuperior ee laf dhabarta 5 ee leh sclerotic hyperplasia ee cirifka (oo ay ku muuqato fallaadha cas). hyperplasia nabarrada ku xiga. Burburinta wadajirka sacroiliac bidix oo ay weheliso burburinta dusha sare ee articular ee ilium, lafo badan oo gudaha ah oo dhintay, iyo hyperplasia unug oo nabar u eg (oo ay ka muuqdaan fallaadho buluug ah).

Fiiro gaar ah: MR oo la xoojiyay: Lumbar 4/5 disc bulge with vertebral rim osteophytes, hypertrophy of flavum ligamentum, cidhiidhi yar ee kanaalka laf-dhabarka, iyo cadaadinta cidhifka hore ee kiish dural. Jidhka vertebral ee lumbar 5 waa mid xaddidan oo loo arki karo sida xargaha dheer ee T1 iyo T2 WI cadaadiska dufanka sare ee calaamadda sare, iyo kobcinta ayaa la arkaa ka dib xoojinta. Calaamado badan oo calaamado aan caadi ahayn ayaa lagu arkaa hoosta dhamaadka lumbar 5 iyo sacral 1 iyo hoosta kala-goysyada sacroiliac, oo leh calaamad hoose oo T1WI ah iyo calaamad yar oo sare oo ku taal T2WI, iyo kor u qaadis ayaa lagu arkay sawirada kor u qaadista (fallaaraha cas). Unug jilicsan oo dhumucdiisuna waxay ku taal darafka hore ee laf dhabarta sacral ayaa la arkay, waxaana kobcinta lagu arkay sawirka kor loo qaaday (Falaarta buluuga ah). Calaamadaha lafaha ilium, sinta, sacrum iyo madaxa femoral ee labada dhinac ee miskaha ma muujin wax aan caadi ahayn oo muuqda, iyo calaamadaha muruqa miskaha gudaha iyo dibaddaba waxay ahaayeen kuwo caadi ah, oo leh muruqa cad cad iyo kala-goysyada wadajirka ah ee caadiga ah, iyada oo aan lahayn calaamado ballaaran oo cidhiidhi ah.

Xididdada lafdhabarta

Gout laf dhabarta waxaa lagu gartaa kaydka monocrystalline urate crystals (MUCs) ee laf dhabarta. Gout-ka laf-dhabarka wuxuu inta badan saameeyaa lafaha lumbar. shucaaca shucaaca ayaa muujinaya astaamo aan gaar ahayn CT-gu waxay si fiican u garanaysaa nabaad-guurka lafaha oo leh geesaha sclerotic. muujinta mri waa kuwo aan gaar ahayn.

Fiiro gaar ah: Sawirka CT-ga ee cad wuxuu muujinayaa meel bannaan oo cidhiidhi ah iyo burburka korka articular ee laba geesoodka ah. Arthrocentesis ayaa loo baahan yahay si loo xaqiijiyo ogaanshaha.

Neurospondylitis

Spondylitis neurogenic (NS), arthropathy horusocod ah oo burburaya, wuxuu dhacaa ka dib luminta dareenka iyo lahaanshaha. Sababta ugu badan ayaa ah dhaawaca laf-dhabarka ee dhaawaca ah, kaas oo xisaabiya 70% kiisaska. Sababaha kale waxaa ka mid ah sonkorowga mellitus, cudurka godadka laf-dhabarka, iyo xanuunada kale ee neerfaha sida murqaha muruqyada peroneal iyo Guillain-Barré syndrome. Sababtoo ah doorka isgoysyada thoracolumbar iyo lumbosacral ee miisaan-qaadista, waxay yihiin goobaha ugu badan ee ku lug leh.

Calaamadaha caadiga ah ee NS waa jajabyada lafaha, is-dhex-galka is-dhex-galka ah ee is-dhexgalka iyo is-waafajin la'aanta taasoo horseedaysa silbashada jirka vertebral, lakabyo badan oo kala duwan iyo nabaad-guurka yaryar ee wadajirka ah iyo sidoo kale ilaalinta cufnaanta lafaha ee sclerosis, iyo sidoo kale unugyada jilicsan.

Fiiro gaar ah: 58 jir lab ah oo leh laf dhabarta neuropathic. (a) Sagittal iyo (b) dib-u-dhiska tomografi ee kombuyuutar ee kombuyuutarku waxay muujinayaan lakabyo badan oo vertebral lumbar ah iyo nabaad-guurka wadajirka ah ee articular synovial ( fallaadho ) oo leh jajabyo lafo. Burburinta qaybta saxanka intervertebral ee L2-L3 iyadoo la ballaarinayo booska intervertebral (asterisk). (c) Sagittal iyo (d) axial t2-miisaanka is-daba-marineed ee miisaanka leh ee xaqiijinaya ballaarinta booska intervertebral L2-L3. wax ka beddelka weyn ee xudunta laf dhabarta ee ay saamaysay xagga dambe ee L2-L3-L4. Waxa kale oo jira dareere ku dhaca unugyada jilicsan ee dambe iyo hore ee hababka lafdhabarta (asterisks).