Cervical Artificial Disc Replacement人工颈椎间盘置换术 A Patient’s Guide to Cervical Artificial Disc Replacement 人工颈椎间盘置换术指南 Introduction简介 相比较而言，人工颈椎间盘置换术是一项新技术。在2004年6月，美国FDA批准开展了第一例人工腰椎间盘置换术。而置换受损的颈椎间盘有点棘手。椎间盘是脊柱中复杂关节的一部分。想要让置换的椎间盘能运作并能持久发挥作用，这并非易事。现如今有几种人工颈椎间盘置换装置已经在美国获得FDA的批准。 The artificial disc is inserted in the space between two vertebrae. The goal is to replace the diseased or damaged disc while keeping your normal neck motion. The hope is that your spine will be protected from similar problems above and below the affected spinal level. 人工间盘植入于两椎体间。其目的是置换病变或损伤的椎间盘并保持颈部正常的运动。希望保护你的脊柱免受相邻病变椎节的影响而产生类似问题。 This guide will help you understand: 本指南将帮助您了解以下内容： · what parts of the spine are involved 病变脊柱部位 · what your surgeon hopes to achieve 外科医生预期疗效 · who can benefit from this procedure 手术适用人群 · how do I prepare for surgery 手术准备 · what happens during the procedure 手术步骤 · what to expect as you recover 术后康复 Anatomy解剖What parts of the spine are involved? 涉及到哪个部位的脊柱？
通常椎间盘置换在颈4-5、5-6或6-7颈椎水平进行。头端七个椎体构成了颈椎。医生们经常所指的颈椎是指颈1到颈7。颈椎起始于颈1与颅底的连接处。颈椎曲度轻度前凸，终止于颈7在胸1连接胸椎处。 Each vertebra is made of the same parts. The main section of each cervical vertebrae, from C2 to C7,is formed by a round block of bone, called the vertebral body. A bony ring attaches to the back of the vertebral body. This ring has two parts. Two pedicles connect directly to the back of the vertebral body. Two lamina bones join the pedicles to complete the ring. The lamina bones form the outer rim of the bony ring. When the vertebrae are stacked on top of each other, the bony rings form a hollow tube that surrounds the spinal cord. The laminae provide a protective wall around the spinal cord. 每个椎体由类似的部分构成。从颈2到颈7，每个颈椎的主要部分是由被称之为椎体的圆形骨块构成。一个骨性环连接椎体背侧。骨环有两部分构成。两个横突直接连接椎体背侧。两侧椎板连接横突封闭骨环。椎板构成了骨环的外侧边缘。当脊椎相互堆叠，骨环则组成了一个围绕脊髓的中空管道。横突提供了围绕脊髓的保护结构。
On the left and right side of each vertebra is a small tunnel called a neural foramen. (Foramina is the plural term.) The two nerves that leave the spine at each vertebra go through the foramina, one on the left and one on the right. The intervertebral disc sits directly in front of the opening. A bulged or herniated disc can narrow the opening and put pressure on the nerve. A facet joint sits behind the foramen. Bone spurs that form on the facet joint can project into the tunnel, narrowing the hole and pinching the nerve. 一个称之为神经孔的小孔道位于每个脊椎的左右两侧。每个脊椎中分出两条神经通过神经孔一左一右离开脊柱。椎间盘直接位于神经孔开口前方。膨出或者突出的椎间盘能使开口变得狭窄继而使神经受压。关节突关节位于神经孔后方。形成于关节突关节的骨刺能突入孔道，狭窄孔道挤压神经。
脊柱中一个特殊结构称为椎间盘，它有两部分。中心富有弹性的称为髓核。它提供大部分的缓冲。髓核受纤维环局限，纤维环是围绕髓核的坚韧的韧带组织。 Related Document: A Patient’s Guide to Cervical Spine Anatomy 相关文献：颈椎解剖指南 Rationale理论基础What does the surgeon hope to achieve? 外科医生希望达到什么？ Disc replacement surgery is done to stop the symptoms of degenerative disc disease. Discs wear out or degenerate as a natural part of aging and from stress and strain on the neck. Eventually, the problem disc collapses. This causes the vertebra above to sink toward the one below. This loss of disc height affects the nearby structures – especially the facet joints. 椎间盘置换手术目的在于阻断退变性椎间盘疾病的症状。由于自然老化或者颈部压力以及应力，椎间盘出现损伤或者退变。最终，病变椎间盘严重损坏。这使得上一个椎体靠近下一个椎体。椎间隙高度的丢失影响了周围结构——尤其是关节突关节。 When the disc collapses, it no longer supports its share of the load in the cervical spine. The facet joints of the spine begin to support more of the force that is transmitted between each vertebra. This increases the wear and tear on the articular cartilage that covers the surface of the joints. The articular cartilage is the smooth, slippery surface that covers the surface of the bone in any joint in the body. Articular cartilage is tough, but it does not tolerate abnormal pressure well for long. When damaged, articular cartilage does not have the ability to heal. This wear and tear is what is commonly referred to as arthritis. 当椎间盘严重损坏，它不再分担颈椎的负重。脊柱的关节突关节开始承受更多来自于脊椎间的压力。这会增加关节突关节表面软骨的磨损以及应力。关节软骨是附着在身体任何关节骨表面光滑的浅层。关节软骨虽然坚韧，但它不能长时间较好的承受非正常压力。当受损，关节软骨无自愈能力。这种关节面磨损以及应力，我们一般称为关节炎。
Shrinking disc height also reduces the size of the neural foramina, the openings between each vertebral pair where the nerve roots leave the spinal column. The arthritis also results in the development of bone spurs that may protrude into these openings, further narrowing the space that the nerves have to exit the spinal canal. The nerve roots can end up getting squeezed where they pass through the neural foramina. 不断压缩的椎间盘高度也减少了椎间孔的尺寸，椎间孔是位于脊椎间的开口，神经根由此离开脊柱。关节炎导致骨刺的形成，这也会突入椎间孔，进一步狭窄神经离开脊髓腔的空间。神经根在通过椎间孔处受压。 The traditional way of treating severe neck pain caused by disc degeneration is a procedure called an anterior cervical discectomy and fusion. In this procedure, the surgeon makes an incision in the anterior (front) of the neck, performs adiscectomy (removes the disc) and fuses the two vertebrae together. A fusion simply means that two bones grow together. Usually, when two vertebrae are fused together, a small piece of bone called a bone graft is inserted between the two vertebrae where the disc has been removed. This bone graft serves to both separate the vertebrae and to stimulate the two bones to grow together – or fuse. 治疗由椎间盘退变引起的严重颈部疼痛的传统方法称为颈前路椎间盘摘除融合术。手术中，外科医生在颈前做一切口，行椎间盘切除，然后融合相邻两个脊椎。融合简单意味着两个骨块生长在一起。通常当两个脊椎融合，需要在两个脊椎中去除椎间盘处植入一小块移植骨。这移植骨充当分离脊椎以及促进脊椎生长在一起或者融合。 The fusion procedure usually involves the use of hardware, such as screws, plates, or cages to keep the bones from moving. Fusion restricts movement in the problem area, but it creates greater strain on the healthy spinal segments above and below. The added strain may eventually cause these segments to wear out. This is called adjacent-segment degeneration. 为了保持椎骨移动，融合术通常需要使用金属器械，例如螺钉，金属板，金属笼。融合术限制病变部位的移位，但它导致上下两侧的正常脊柱节段更严重的应力。增加的应力最终导致这些节段的磨损。这称为相邻节段退变。 Replacing the damaged disc with an artificial disc, or implant, called a prosthesiscan restore the normal distance between the two vertebrae. The artificial disc sits between the two vertebrae and “jacks up” the upper vertebra. Enlarging the disc space relieves pressure on the facet joints. It also opens up the space around the spinal nerve roots where they pass through the neural foramina. 用人工椎间盘或者假体替换受损的椎间盘恢复了脊椎间的正常距离。人工椎间盘位于两脊椎间，并顶起上位脊椎。增大的椎间盘空间缓解了关节突关节的压力。同时也扩大了脊神经根通过神经孔的空间。 Another benefit of the artificial disc replacement is that it mimics a healthy disc. Natural motion is preserved in the spine where the new disc is implanted. And it helps maintain stability in the spinal joints above and below it. 人工椎间盘置换术的另一优点是它模拟了正常椎间盘。所植入的人工椎间盘能维持脊柱正常运动。它有助于维持脊柱关节的稳定。 Who can benefit from this procedure哪些人适合做这个手术 The indications for a cervical disc replacement are generally the same as for a cervical discectomy and fusion. A person must have symptoms from a cervical disc problem. Symptoms include neck and/or arm pain, arm weakness, or arm and hand numbness. These symptoms may be due to a herniated disc and/or bone spurs called osteophytes pressing on adjacent nerves or the spinal cord. This condition typically occurs at cervical spine levels C4-5, C5-6, or C6-7. 一般说来，颈椎间盘置换术的适应症与颈椎间盘切除融合术相同。患者必须有颈椎间盘疾患的症状。这包括颈或者手臂疼痛，上肢无力，或者手臂以及手麻木。这些症状可能由于脱出的椎间盘或骨刺挤压毗邻的神经或者脊髓所致。这种情况一般发生在颈4-5、5-6或6-7水平。 Artificial disc replacement is still somewhat new in the United States. In the United States, surgeons are currently only replacing one cervical disc in a patient’s cervical spine at this time. In Europe, surgeons are replacing more than one disc. More surgeons in the United States will probably start replacing more than one cervical disc in the near future. 人工椎间盘置换术在美国仍是新技术。目前在美国，外科医生仅能在一个病人的颈椎置换一个椎间盘。在欧洲，外科医生能置换超过一个椎间盘。在美国更多的外科医生将可能开始在不远的将来置换不止一个椎间盘。 Cervical artificial disc replacement is indicated for the treatment of radiculopathy(pressure on the spinal nerve) and myelopathy (pressure on the spinal cord) at one or two levels. In the future, it may be used for the treatment of three or more symptomatic levels or levels adjacent to a cervical spine fusion. This use is still under investigation. 人工颈椎间盘置换术适用于一到两个水平的神经根型颈椎病以及脊髓型颈椎病。在将来，它将被用于治疗与颈椎融合术相似的三个或者更多病变水平。这种方法仍待检验。 More data is needed before the uses of cervical artificial disc replacements are expanded to other problems in the cervical spine. Cervical artificial disc replacement is not advised when there is cervical spine instability, significant facet joint damage, or infection. 在扩大应用人工颈椎间盘置换术到颈椎其他问题前，需要搜集更多数据。当有颈椎失稳，明显的关节突关节损伤或者感染时，不建议行颈椎间盘置换术。 Preparation准备 How should I prepare for surgery? 我需要为手术做哪些准备呢？ Your spine surgeon will gather a variety of information before recommending disc replacement surgery. In addition to taking a history and doing a physical exam, your surgeon may order various diagnostic studies, such as x-rays, magnetic resonance imaging (MRI) scans, CT scans, or discograms. 你的脊柱外科医生将在提议椎间盘置换术前搜集各类信息。除病史采集以及体格检查外，外科医生可能会安排各种诊断性检查例如X线、核磁共振、CT或者造影术。 Once you and your surgeon have agreed that disc replacement surgery is indicated, certain preparations for the surgery are important. Your doctor may tell you to be NPO for a certain amount of time before the procedure. This means that you should not eat or drink anything for a certain amount of time before your procedure. This means no water, no coffee, no tea – not anything. You may receive special instructions to take your usual medications with a small amount of water. Check with your doctor if you are unsure what to do. 一旦你和你的外科医生都同意椎间盘置换手术，某些外科术前准备是很重要的。你的医生可能会让你在术前禁食一段时间。这意味着你在术前一段时候不能吃或喝任何东西。这表示不能喝水、喝咖啡、喝茶等等任何东西。你可能需要接受特殊医嘱，用少量水服用你平时的药物。如果你不确定你要做什么，询问你的医生。 You should tell your doctor if you are taking any medications that thin your blood or interfere with blood clotting. The most common blood thinner is Coumadin. Other medications also slow down blood clotting. Aspirin, ibuprofen, and nearly all of the anti-inflammatory medications affect blood clotting. So do medications used to prevent strokes such as Plavix. These medications usually need to be stopped seven days prior to the procedure. Be sure to let your doctor know if you are on any of these medications. 如果你正在服用任何药物来稀释血液或者影响血液凝固，你应当告诉你的医生。最常见的血液稀释药物是香豆定。其他药物也减慢血液凝固。阿司匹林，布洛芬以及近乎所有抗炎药物都影响血液凝固。同样的用于预防中风的药物例如波力维。这些药物通常需要术前停用7天。如果你在服用任何这些药物，一定要告诉你的医生。 You should stop smoking or using tobacco in any form as soon as possible before surgery. This is very important to reduce complications from heart and lung problems. Tobacco use, especially smoking, also decreases the success rate of spine surgery. Stopping smoking will increase your chances of a successful result. 术前你应当尽可能戒烟或者任何形式的烟草。这对于减少心肺并发症很重要。烟草使用尤其吸烟也会降低脊柱手术成功率。戒烟会增加你手术成功的几率。 Discussions will be held with your family and people who may be assisting you once you return from the hospital. You may need to visit your primary care physician or internal medicine specialist to obtain medical clearance for surgery. This will ensure that you are in the best medical condition possible prior to the surgery. 一旦你出院，需要和你的家人以及你的护理人员进行商讨。你需要向你的康复医师或者内科专科医师为手术获得医疗许可。这能确保你在术前处于最佳医学状态。 Hospitals often have preoperative teaching for patients undergoing major spinal operations. These teaching sessions can help you understand what to expect both while you are in the hospital and after you return home. A doctor who will be performing your anesthesia (an anesthesiologist) will evaluate and counsel you regarding anesthesia. 医院通常会对准备行脊柱大手术的病人开展术前宣教。这种教育活动能帮助你了解当你在院以及出院所需要做的事情。你的麻醉师的医生会评估以及咨询你相关的 麻醉事项。 Surgical Procedure手术步骤 What happens during the operation? 手术如何进行呢? Before we describe the procedure, let’s look first at the artificial disc itself. 在讲述手术前，让我们首先看看人工椎间盘。
The cervical artificial disc has several different designs. Some look like a sandwich with two endplates separated by a plastic spacer. The two endplates are made of cobalt chromium alloy, a safe material that has been used for many years in replacement joints for the hip and knee. 人工颈椎间盘有几种不同的设计。一些看起来像三明治，它有两个有塑料垫分隔的终板。这两个终板有钴铬合金制成，这是一种多年来被用于髋以及膝关节置换的安全材料。 A plastic (polyethylene) core fits in between the two metal endplates. The core acts as a spacer and is shaped so that the endplates pivot in a way that imitates normal motion of the two vertebrae. There are small prongs on one side of each endplate. The prongs help anchor the endplate to the surface of the vertebral body. 一种塑料核心填入两个金属终板中。这个核心充当间隔器，其形状利于终板回转滚轴，从而模仿两脊椎的正常运动。在每个终板的一侧有小的叉子，这些叉子能将终板固定在椎体表面。 Another artificial disc replacement design is a ball and socket articulation to allow for normal translation of motion at that segment. The implant may be made of titanium and polyurethane in a metal-on-plastic design. Some are made of stainless steel and are all metal-on-metal. 另一种人工椎间盘设计是一个球和臼连接，利于节段正常的运动。植入物可能由钛和聚氨酯以一种金属-塑料结构设计。一些是由不锈钢构成臼,构成全金属-金属连接。 Inserted between two vertebrae, the prosthesis reestablishes the height between two vertebrae. As a result of enlarging the disc space, the nearby spinal ligaments are pulled tight, which helps hold the prosthesis in place. The prosthesis is further held in place by the normal pressure through the spine. 植入两脊椎之间的假体能重塑脊椎间的高度。扩大的椎间隙可以使得脊柱周围的韧带被拉紧，这有助于固定假体在位。脊柱间正常的压力进一步将假体固定在位。 The Operation手术 The operation is done from the anterior (front) of the body. This surgical approach is the same as that presently used for a discectomy and fusion operation. To do this, the patient is placed on his or her back. An incision is made through the skin and the thin muscles of the front of the neck. The blood vessels, the trachea (windpipe), and the esophagus are moved to the side so that the surgeon can see the front of the cervical spine. The disc that is to be replaced is identified using thefluoroscope. The fluoroscope is an x-ray machine that allows the doctor to actually see an x-ray image while doing the procedure. 手术应用前路入路。这种外科方法与目前椎间盘切除以及融合术相同。为了这么做，患者取仰卧位。切口经皮肤以及颈阔肌。将血管、气管以及食管移到一侧，这样能使手术医生看到颈椎前缘。使用透视明确需要置换的椎间盘。透视是应用一种X线机，它能使医生在手术时看到X线片。 Working from the front of the spine, the spine surgeon removes a large section from the middle of the damaged disc. Next, the bones of the spine are spread apart to make more room to see and work inside the disc space. Using a surgical microscope, any remaining disc material toward the back of the disc is removed. The surgeon will also remove any disc fragments pressing against the nerve and shave off any osteophytes (bone spurs). 从脊椎前路手术，脊柱外科医生移除病变椎间盘中央大部分。然后，清除椎体前缘多余的骨赘以扩大椎间隙手术操作视野以及操作区域。用外科显微镜来清除背侧残留的椎间盘组织。外科医生会切除压迫神经的椎间盘碎片，或者切除骨赘（骨刺）。 The disc space is distracted (jacked up) to its normal disc height. This step helps decompress or take pressure off the nerves. At this point, x-rays or a fluoroscope, is used to insert the artificial disc device into the prepared disc space. This allows the doctor to watch where the implant goes as it is inserted. This makes the procedure much safer and much more accurate. 撑开椎间隙到正常高度。这一步有助于减压或者去除神经压迫。此时，X线或者透视用于植入人工椎间盘到减压好的椎间隙。这让医生能观察植入物的位置。这也让手术更安全更准确。
Finally, the prosthesis is tested by moving the spine in various positions. An X-ray may be taken to double check the location and fit of the new disc. 最后，通过按不同方位移动脊柱来测试假体。使用X线正侧位检查新椎间盘的位置以及匹配。 View animation of artificial disc replacement 观看人工椎间盘置换术动画精美动画：人工颈椎间盘置换术（附中英文解说）翻译：郭晓峰（南通大学2016届骨科研究生） 校对：保国锋 保国锋，南通市第一人民医院脊柱外科，副主任医师，硕士生导师、医学博士。江苏省“333高层次人才”培育对象、南通市医学重点人才、南通市“226高层次人才”培养对象。社会兼职：江苏省医学会骨科分会创伤学组委员、江苏省中西医结合学会骨科分会委员、北美脊柱外科学会(NASS)会员、南通市中西医结合学会骨科分会委员。擅长颈肩腰腿痛、脊柱脊髓损伤、脑瘫等手术治疗。2011年、2014年、2016年曾在澳大利亚Latrobe大学、德国OberlinHaus医院、德国科隆大学医院和韩国首尔国立大学医院（SNUH）研修脊柱外科。 门诊时间：周五全天 患者指南，图文并茂， 分门别类，构思巧妙。 深入浅出，中英对照， 医患携手，共同探讨。 能力有限，时间仓促， 错误难免，诚惶诚恐。 恳请各位，留言指导， 以利再版，更加周到。 |
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