Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
The neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2xity. The bony structure of the neck is the cervical spine with seven vertebrae., arranged in a lordotic configuration of 16 to 25 degrees. This physiologic lordosis is never quite reversed, even in flexion, unless under pathologic conditions.Important palpable landmarks of the neck arc the hyoid bo Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2ne, which lies at the level of C3, the thyroid cartilage, lying in front ofC4, and the cricoid cartilage, at the level of C6 (Figure 17.1).The seven cEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
ervical vertebrae arc different in shape. T he first two, the atlas (Cl) and the axis (C2), are morphologically different from all the other five vertThe neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2ck anterior and posterior arches merging laterally into large masses through which it articulates with the occipital condyles above and the axial facet joints below.The axis originates from six ossification centres. The vertebral body has a characteristic superior peg, the dens, which articulates wi Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2th the posterior surface of the anterior arch of the atlas. The dens can have a posterior angulation of up to 30 degrees. The transverse ligament of tEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
he atlas runs across the back of a narrowed waist of the odontoid process, stabilizing the joint, particularly in rotation. The ossification of the deThe neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2 the dens starts at 3-5 years of age and will only be completely fused at a later stage, during adolescence. The large spinous process of the axis allows for muscle insertion, namely the rectus capitis Ane\ the inferior oblique muscles.The subaxial cervical spine extends from C3 to C7. With a smalle Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2r vertebral body, the subaxial cervical vertebrae, although similar in shape, differ from the vertebrae in other segments of the spine because these hEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
aw two transverse foramina for the vertebral arteries, running from C6 (in 90% of cases) to Cl, and two vertebral foramina for the nene roots. The verThe neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2oncave shape to the superior end plate and participate in the motion pattern of the cervical spine, coupling bending and rotation.Lamina—Intervertebral spaceFigure 17.1 Radiological anatomy of the cervical region (Reproduced With permission from: Todd MM. Cervical spine anatomy and function for the Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2anesthesiologist. Can J Anaesth 2001; 48($uppl 1): R1-R5.)2REGIONAL ORTHOPAEDICSThe short and medially oriented pedicles connect the vertebral body wiEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
th the lateral masses. The diameter of the pedicles increases downwards, with C6 pedicles being the largest.The cervical articular facets arc orientedThe neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2ior ventroinfe-riorly. Spinous processes AK often bifid from C2 to C6, and the C7 spinous process is usually longer, the reason why it is called the vertebra prominent.The primary function of the subaxial cervical spine is to resist compressive forces. The facets arc part of a tripod of stable joint Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2s (two facets and one intervertebral disc) allowing flexion/cxtcnsion, lateral bending and slight rotation. Under abnormal distractivc forces they mayEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
also allow subluxation or dislocation to occur (even without fracture), a displacement that is usually prevented by the strong posterior ligaments.ThThe neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2 cord elongates and ‘squeezes’ in flexion and shortens and enlarges in extension. As much as 30% ofcord compression can irreversibly damage the spinal cord.The cervical spine contains eight pairs of nerve roots. They pass through relatively narrow neural foramina, above the similarly numbered verteb Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2ra, the first between the occiput and Cl, and the eighth between C7 and the first thoracic (Tl) vertebra. Hence, a lesion such as a disc prolapse betwEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
een C5 and C6 might compress the sixth root.Intervertebral discs lie between the vertebral bodies, with their posterior margin close to the nerve rootThe neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2toms (with radiating pain and paracsthesiac to the shoulder or upper limb) rather than neck pain.Degenerative dtse disease is associated with spur formation on both the posterior aspect of the vertebral body and the associated facet joints. Bone formation results in encroachment of the nerve root in Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2 the intervertebral foramen. Radiating pain can also be caused by facet joint degeneration or the soft surrounding structures. Facctary pain is typicaEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
lly aggravated with extension, lateral bending and rotation. Only radiculopathy (i.c. paracsthcsiac and sensory or motor compromise) with shooting paiThe neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2cxtcnsion, lateral bending and axial rotation. Head motion is a combination of all these movements.The occipitocervical junction contributes to approximately 50% of the neck flexion-extension movement(the 'YES' joint), with a C0-C1 range of motion of 21 degrees of flexion and 3.5 degrees of extensio Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2n. At the atlanto-occipital joint, the movements that occur arc nodding and tilting (lateral flexion).The atlantoaxial articulation contributes to appEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
roximately 50% of neck rotation (the ‘jVO’ joint), with a C1-C2 range of motion of 47 degrees of axial rotation. The vertebral artery loop in this regThe neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2bending. The majority of the flexion-extension movement in the subaxial cervical spine occurs at the level of C4-C5 and C5-C6, the reason why these levels are more frequently affected in the degenerative process of the disc. The majority of lateral bending occurs from C2 to C4. The least mobile segm Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2ent in the cervical spine is C7-T1 because it is usually deeply seated into the upper chest.Surgical approaches to thecervical SPINEThe Smtth-RobinsonEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
-Cloward approach is the most widely used for anterior cervical surgery. The spine is accessed through a slightly oblique skin incision on the side ofThe neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2 the anterior cervical fascia on the medial border of the SC.M. Progression medially to the carotid sheath, which is dorsolateral to the visceral space and ventrolateral to the prcvcrtebral fascia, provides direct access to the midiinc of the anterior cervical spine. The cervical sympathetic chain i Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2s located postcromedially to the carotid sheath. The thoracic duct lies posterior to the carotid sheath on the left side. Sometimes crossing the operaEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
tive field, the omohyoid muscle may be divided to facilitate the access. The anterior surface of the spine, just over the anterior longitudinal ligameThe neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2bral muscles.The oesophagus at this level lies in front of the spine and behind the trachea. Due to its soft structure it can be easily injured if caution is not taken during the approach. Dysphagia is a common complication of anterior surgery of the cervical spine, although most frequently its aeti Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2ology is unclear.The recurrent laryngeal nerve is another structure that is at risk in the cervical spine anterior approach. It supplies motor innervaEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
tion to the intrinsic laryngeal muscles that control movement of the vocal cords and also supply sensory456innervation to the larynx below the vocal cThe neckJorge Mineiro & Nuno LancaAPPLIED ANATOMYAnatomical considerations of theCERVICAL SPINEThe neck has a gentle curvature with an anterior convex Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2clavian artery and travels upwards being susceptible to injury by traction from the retractors, may cause hoarseness (or aphonia, if injured bilaterally). Disruption of the inferior sympathetic cervical (stellate) ganglion, which lies in front of the C7 transverse process, can result in Horner syndr Ebook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2ome.Anatomical variations of the course of the vertebral artery exist, such as medial loops of the vertebral artery or even the internal carotid arterEbook Apley and Solomon’s system of orthopaedics and trauma (10/E): Part 2
y, and these may increase the risk of surgical complications in anterior spine approaches (Figure 17.2). They arc more likely in congenital and in cerGọi ngay
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