Cervical Discectomy颈椎间盘切除术A Patient’s Guide to Cervical Discectomy颈椎间盘切除术患者指南Introduction介绍
Cervical discectomy is surgery to remove one or more discs from the neck. The disc is the pad that separates the neck vertebrae; ectomy means to take out. Usually a discectomy is combined with a fusion of the two vertebrae that are separated by the disc. In some cases, this procedure is done without a fusion. A cervical discectomy without a fusion may be suggested for younger patients between 20 and 45 years old who have symptoms due to a herniated disc. 颈椎间盘切除术是一种将颈部一个或多个节段椎间盘切除的外科手术。颈椎间盘是一种分隔相邻各颈椎椎体的垫片；ectomy（切除术）就是把颈椎间盘切除并取出的意思。通常情况下，椎间盘切除后，接着需行融合手术，将上下相邻的被椎间盘分隔的椎体连接起来。但在一部分病例中，如20-45岁的年轻的椎间盘突出的患者，可以只切除椎间盘而不再进行融合术。 This guide will help you understand · why the procedure becomes necessary · what surgeons hope to achieve · what to expect during your recovery 这个指南将让大家明白以下内容： · 为什么手术是必要的？ · 外科医生期望得到什么样的结果？ · 患者康复时可能遇到什么样的问题？ Anatomy解剖学
What parts of the neck are involved? 涉及到颈部的哪些结构？
Surgeons usually perform this procedure through the front of the neck. This is called the anterior neck region. Key structures include ligaments, bones, intervertebral discs, spinal cord, spinal nerves and the neural foramina. 外科医生通常选择做颈前部切口作为手术入路的选择，这被称作颈前路入路。其中关键结构包括韧带，骨，椎间盘，脊髓，脊神经和神经孔。
Surgery is occasionally done through the back, or posterior region, of the neck. Important structures in this area include the ligaments and bones, especially the lamina bones. 外科手术也偶尔选择背侧或者颈后路入路。在这个区域中的重要结构包括：韧带，骨，尤其是椎板。
Related Document: A Patient’s Guide to Cervical Spine Anatomy 相关阅读：英汉对照：有关颈椎解剖的病人指南 相关视频： 骨科小病不求医050：颈椎解剖（Cervical Spine Anatomy） 骨科小病不求医052：脊柱解剖（Spine Anatomy） 警告：请在有WIFI的场所观看视频，土豪请随意。 本视频由张正阳翻译，更多解剖视频，请关注微信公众平台《张正阳Thomas》 Rationale基本原理
What do surgeons hope to achieve? 外科医生期望得到什么样的结果？
Discectomy is used to alleviate symptoms of a herniated disc. A disc herniation happens when the nucleus inside the center of the disc pushes through the annulus, the ligaments surrounding the nucleus. The herniated disc material may push outward, causing pain. Numbness or weakness in the arm occurs when the nucleus pushes on the spinal nerve root. Of greater concern is a condition in which the nucleus herniates straight backward into the spinal cord, called a central herniation. Discectomy relieves pressure on the ligaments, nerves, or spinal cord. 颈椎间盘切除术可以缓解颈椎间盘突出症的症状。颈椎间盘突出症是指位于椎间盘中心的髓核穿破其周围的纤维环和韧带，并向外挤压神经引起疼痛的疾病。髓核压到椎管内的神经根，手臂就会产生麻木和无力的症状。若突出的髓核径直向后压迫脊髓，我们称之为中央型突出。颈椎间盘切除术通过对周围韧带、神经和脊髓的减压来达到缓解症状的目的。
Discectomy is also commonly used when the surgeon plans to fuse the bones of two neck vertebrae into one solid bone. Most surgeons will take the disc out and replace the empty space with a block of bone graft, a procedure called cervical fusion. 外科医生在对相邻两个颈椎进行融合时也常会用到颈椎间盘切除术。大多数外科医生在术中都会把椎间盘取出，并用一块移植骨填补这个空隙，这个步骤称为颈椎融合。
Discectomy alone is usually only used for younger patients (20 to 45 years old) whose symptoms are from herniation of the disc. But some surgeons think discectomy should always be combined with fusion of the bones above and below. They are concerned that the empty space where the disc was removed may eventually collapse and fill in with bone. Inserting a bone block during fusion surgery helps keep pressure off the spinal nerves because the graft widens the neural foramina. The neural foramina are openings on each side of the vertebrae where nerves exit the spinal canal. Most research on discectomy by itself shows good short-term benefits compared to discectomy with fusion. But more information is needed about whether the long-term results are equally as good. 单纯髓核摘除术通常只适用于那些只表现为颈椎间盘突出症的年轻患者（20-45岁）。但有些医生认为髓核摘除联合相邻颈椎融合效果更好。他们担心将椎间盘拿掉后，如果不填充移植骨做融合，剩下的空隙最后很有可能塌陷。脊神经经过椎体两侧的椎间孔自脊髓发出，融合术中填塞的骨块可以扩大椎间孔来避免脊神经所压。大量研究证明，相对于髓核摘除加融合术，单纯的髓核摘除术短期效果更好。但是，单纯的髓核摘除术是否和髓核摘除加融合术一样有着良好的长期疗效，有待更多的研究来证实。
Preparations术前准备
How will I prepare for surgery? 术前需要哪些准备工作？
The decision to proceed with surgery must be made jointly by you and your surgeon. You should understand as much about the procedure as possible. If you have concerns or questions, you should talk to your surgeon. 是否进行手术需要你和你的外科医生共同决定。你应该更可能多的知道手术的相关步骤。如果你有疑问，应该和你的外科医生及时沟通。 Once you decide on surgery, your surgeon may suggest a complete physical examination by your regular doctor. This exam helps ensure that you are in the best possible condition to undergo the operation. 一旦你决定进行手术，你的外科医生会建议你的私人医生给你进行一次全面的体格检查，以保证术前良好的身体状况。
On the day of your surgery, you will probably be admitted to the hospital early in the morning. You shouldn’t eat or drink anything after midnight the night before. 手术当天，你需要尽早到医院。从术前那晚的午夜开始不能进食、喝水。 Surgical Procedure手术步骤 What happens during the operation? 手术是怎么样进行的？ Cervical discectomy is commonly done through the anterior(front) of the neck. This is called an anterior cervical discectomy. However, when many pieces of the herniated disc have squeezed into the posterior (back) of the spine, surgeons may need to operate through the back of the neck using a procedure called a posterior cervical discectomy. 颈椎间盘切除术通常是通过颈前入路来完成的，称为颈椎前路椎间盘切除术。但是，当一些破碎的髓核被挤压进入椎体后方时，医生可能需要通过颈后入路来摘除这些髓核，称为颈椎后路椎间盘切除术。 Patients are given a general anesthesia to put them to sleep during most spine surgeries. As you sleep, your breathing may be assisted with aventilator. A ventilator is a device that controls and monitors the flow of air to the lungs. 大多数脊柱手术中病人采用全身麻醉，整个手术中，病人都是在睡眠状态。当病人睡着时，由呼吸机辅助呼吸。呼吸机是一种能够控制和监测空气流动到肺的装置。
Anterior Discectomy前路椎间盘切除术
The patient’s neck is positioned facing the ceiling with the head bent back and turned slightly to the right. A two-inch incision is made two to three fingers’ width above the collar bone across the left-hand side of the neck. The left side is chosen to avoid injuring the nerve going to the voice box. Retractors are used to gently separate and hold the neck muscles and soft tissues apart so the surgeon can work on the front of the spine. 病人仰卧，头部向后仰，并轻微转向右侧。在左侧颈部锁骨上两到三指作一到二英寸的切口。选择左侧是为了避免损伤支配喉的神经。用牵开器轻轻分离并保持颈部肌肉和软组织分开，这样术者可以在脊柱的前方操作。
A needle is inserted into the herniated disc, and an X-ray is taken to identify and confirm it is the correct disc. A long strip of muscle and the anterior longitudinal ligament that cover the front of the vertebral bodies are carefully pulled to the side. Forceps are used to take out the front half of the disc. Next a small rotary cutting tool (a burr) is used to carefully remove the back half of the disc. A surgical microscope is used to help the surgeon see and remove pieces of disc material and any bone spurs that are near the spinal cord. 穿刺针插入突出椎间盘，X线确认它是正确的节段。将覆盖椎体前方的肌肉（颈长肌）和前纵韧带小心拉向一侧。用髓核钳取出椎间盘的前半部分。然后用旋转切割工具（磨钻）仔细去除后半部的椎间盘。使用手术显微镜帮助外科医生看到和切除脊髓周围的椎间盘碎片和骨刺。
The muscles and soft tissues are put back in place, and the skin is stitched together. 将肌肉和软组织归回原位，缝合皮肤。
Posterior Discectomy后路椎间盘切除术 This method is used when the herniated disc has fragmented into small pieces near the spinal nerve. 椎间盘突出已经碎裂成小块并靠近脊神经时采用这种手术方式。
The operation is usually done with the patient lying face down with the neck bent forward and held in a headrest. The surgeon makes a short incision down the center of the back of the neck. The skin and soft tissues are separated to expose the bones along the back of the spine. 手术时，病人通常采取俯卧位，颈部前曲，置于头架上。外科医生沿着颈部后方中线做一短切口。分离皮肤、软组织以暴露脊柱后部的骨性结构。 Then the surgeon may use an X-ray to identify the injured disc. A burr is used to shave the edge off the lamina bones, the back part of the ring over the spinal cord. When the disc has jutted straight backward into the spinal cord (central herniation), surgeons may need to completely remove both lamina bones in order to see better and to be able to clear all the pieces of the disc near the spinal cord. 然后外科医生用X线来识别破损的椎间盘。用磨钻削除椎板边缘，即围在脊髓背面的部分。当椎间盘径直向后突向脊髓（中央突出），外科医生可能需要完全去除两边的椎板以便更好观察，并清除脊髓周围所有的椎间盘碎片。
Related Document: A Patient’s Guide to Cervical Laminectomy 相关阅读：颈椎椎板切除术患者指南（翻译招募中，有兴趣者请留言） 相关视频： After shaving the lamina bone, the surgeon cuts a small opening in the ligamentum flavum, a ligament within the spinal canal and in front of the lamina bone. By removing part of this ligament, the surgeon exposes the spot where the disc fragments are pressed against the spinal nerve. Next, the spinal nerve is gently moved upward. Using a surgical microscope, the surgeon magnifies the area in order to carefully remove the disc fragments and any bone spurs. 将椎板部分消除后，术者会在黄韧带上切个小口，该韧带位于椎板前方的椎管内。通过去除部分黄韧带，术者能够暴露椎间盘碎片压迫脊神经的位置。然后，轻轻向上牵拉脊神经。使用手术显微镜，外科医生放大手术视野以小心取出椎间盘碎片和骨刺。
The muscles and soft tissues are put back in place, and the skin is stitched together. 将肌肉和软组织归回原位，缝合皮肤。
Complications并发症
What might go wrong? 手术可能会出现哪些问题？
As with all major surgical procedures, complications can occur. Some of the most common complications following discectomy include 和所有主要手术一样，颈椎间盘切除术也会出现并发症，最常见的并发症包括：
· problems with anesthesia · thrombophlebitis · infection · nerve damage · ongoing pain
· 麻醉并发症 · 血栓性静脉炎 · 感染 · 神经损伤 · 持续疼痛
This is not intended to be a complete list of the possible complications, but these are the most common. 这里没有完整列出所有可能发生的并发症，但这些是最常见的。
Problems with Anesthesia 麻醉并发症 Problems can arise when the anesthesia given during surgery causes a reaction with other drugs the patient is taking. In rare cases, a patient may have problems with the anesthesia itself. In addition, anesthesia can affect lung function because the lungs don’t expand as well while a person is under anesthesia. Be sure to discuss the risks and your concerns with your anesthesiologist. 当在手术期间所实施的麻醉与患者正在服用的其他药物发生反应时，可能就会发生并发症。极少数情况下病人出现问题是由麻醉本身所引起。另外麻醉也会影响肺功能，因为在麻醉状态下肺扩张不好，因此一定确保与你的麻醉师交流手术的风险和你的关注点。
Thrombophlebitis (Blood Clots) 血栓性静脉炎 View animation of pulmonary embolism Thrombophlebitis, sometimes called deep venous thrombosis (DVT), can occur after any operation. It occurs when the blood in the large veins of the leg forms blood clots. This may cause the leg to swell and become warm to the touch and painful. If the blood clots in the veins break apart, they can travel to the lung, where they lodge in the capillaries and cut off the blood supply to a portion of the lung. This is called a pulmonary embolism. (Pulmonary means lung, and embolism refers to a fragment of something traveling through the vascular system.) Most surgeons take preventing DVT very seriously. There are many ways to reduce the risk of DVT, but probably the most effective is getting you moving as soon as possible. Two other commonly used preventative measures include 血栓性静脉炎，有时称为深静脉血栓形成（DVT），可在任何手术后发生。当腿的大静脉中的血液形成血凝块时它就会发生。这可能会导致大腿肿胀，摸上去皮温有升高，并有疼痛，如果在静脉中的血栓掉下来，它们可以游行至肺，停留在毛细血管中并会切断肺的一部分血供。这就叫做肺栓塞，栓塞指的是某些物品的碎片通过血管系统转运。大多数外科医生非常重视预防深静脉血栓，有很多方法可以减少深静脉血栓的风险，但最有效的方法是尽快进行活动。另外有两种最常见的方法包括： · pressure stockings to keep the blood in the legs moving · medications that thin the blood and prevent blood clots from forming · 使用弹力网保持腿部血液的流动 · 使用能降低血液稠度和阻止血栓形成的药物
Infection 感染 Infection following spine surgery is rare but can be a very serious complication. Some infections may show up early, even before you leave the hospital. Infections on the skin’s surface usually go away with antibiotics. Deeper infections that spread into the bones and soft tissues of the spine are harder to treat and may require additional surgery to treat the infected portion of the spine. 脊柱术后出现感染很罕见，但这却是一个非常严重的并发症。有些感染甚至在你出院之前就已经出现了，皮肤表面出现的感染通常在使用抗生素后会消失，但蔓延到脊柱骨和软组织的深部感染却更难治疗，可能需要另外的手术来治疗脊柱受感染的部分。
Nerve Damage 神经损伤
Any surgery that is done near the spinal canal can potentially cause injury to the spinal cord or spinal nerves. Injury can occur from bumping or cutting the nerve tissue with a surgical instrument, from swelling around the nerve, or from the formation of scar tissue. An injury to these structures can cause muscle weakness and a loss of sensation to the areas supplied by the nerve. 在椎管附近的任何手术都有可能引起脊髓和脊神经的损伤。当手术器械碰撞或切割到神经组织时会出现损伤，神经损伤也可以出现在神经周围的肿胀或疤痕组织的形成。神经损伤可导致神经支配区域肌肉无力和感觉缺失。 The nerve to the voice box is sometimes injured during surgery on the front of the neck. When doing anterior neck surgery, surgeons prefer to go through the left side of the neck where the path of the nerve to the voice box is more predictable than on the right side. During surgery, the nerve may get stretched too far when retractors are used to hold the muscles and soft tissues apart. When this happens, patients may be hoarse for a few days or weeks after surgery. In rare cases where the nerve is actually cut, patients may end up with ongoing minor problems of hoarseness, voice fatigue, or difficulty making high tones. 在手术期间，脖子前部的喉部神经有时会损伤。 当进行颈前路手术时，外科医生更喜欢通过左侧颈部，其喉部神经的路径比在右侧更容易预测。在手术期间，用拉钩来分离肌肉和软组织时，神经可能被牵扯太远。当发生这种情况时，患者可能在术后几天或几周出现声音嘶哑。在极少数情况下，神经真正被切断了，患者最终可能会遗留持续的声音嘶哑，发音疲劳或高音困难等小问题。
Ongoing Pain 持续疼痛 Many patients get nearly complete relief of symptoms from the discectomy procedure. As with any surgery, however, you should expect some pain afterward. If the pain continues or becomes unbearable, talk to your surgeon about treatments that can help control your pain. 通过椎间盘切除手术，许多患者症状几乎完全缓解。但是，与任何手术一样，你应该对术后的一些疼痛有心理准备。如果疼痛持续或变得难以忍受，告诉您的手术医生，以便可以帮助您控制疼痛。 After Surgery手术后
What happens after surgery? 手术后会发生什么？
Patients are usually able to get out of bed within an hour or two after surgery. Your surgeon may have you wear a hard or soft neck collar. If not, you will be instructed to move your neck only carefully and comfortably. 患者通常在术后一两个小时内就可以下床。外科医生可能会让您戴一个硬的或软的颈托。如果没有，医生会指导您只能在小心和舒适的情况下才能活动脖子。
Most patients leave the hospital the day after surgery and are safe to drive within a week or two. People generally get back to light work by four weeks and can do heavier work and sports within two to three months. 大多数患者在术后的第二天出院，并且在一两个星期内可以安全驾驶。患者通常在四个星期之后可以恢复轻松的工作，并且在两三个月内可以做更重的工作和运动。
Outpatient physical therapy is usually prescribed only for patients who have extra pain or show significant muscle weakness and deconditioning. 通常只有那些特别疼痛或有明显的肌肉无力和功能失调的患者才需要进行门诊物理治疗。 Rehabilitation康复
What should I expect as I recover? 在恢复期需要做些什么？
Patients usually don’t require formal rehabilitation after routine cervical discectomy surgery. Surgeons may prescribe a short period of physical therapy when patients have lost muscle tone in the shoulder or arm, when they have problems controlling pain, or when they need guidance about returning to heavier types of work. 常规颈椎椎间盘切除手术后，患者通常不需要进行正式的康复锻炼。当患者的肩膀或手臂的肌肉失去张力时，当他们有难以控制的疼痛时，或者当他们返回更重的工种需要有关的指导时，外科医生会开出短期物理治疗的处方。
If you require outpatient physical therapy, you will probably only need to attend therapy sessions for two to four weeks. You should expect full recovery to take up to three months. 如果您需要门诊物理治疗，您可能只需要两到四周的疗程。预计完全恢复可能需要三个月的时间。
At first, therapy treatments are used to help control pain and inflammation. Ice and electrical stimulation treatments are commonly used to help with these goals. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain. 首先，采用某些治疗方法来帮助控制疼痛和炎症。冰敷和电刺激治疗方法通常用来帮助实现这些目标。您的治疗师还可以用按摩和其他手法治疗以缓解肌肉痉挛和疼痛。
Active treatments are added slowly. These include exercises for improving heart and lung function. Walking, stationary cycling, and arm cycling are ideal cardiovascular exercises. Therapists also teach specific exercises to help tone and control the muscles that stabilize the neck and upper back. 然后慢慢地加入运动疗法。这些包括用于改善心肺功能的锻炼。步行，骑固定式自行车和手臂自行车是理想的心血管锻炼方法。治疗师还教授特定的练习，以帮助调节和控制稳定颈部和上背部的肌肉。
Your therapist works with you on how to move and do activities. This form of treatment, called body mechanics, is used to help you develop new movement habits. This training helps you keep your neck in safe positions as you go about your work and daily activities. You’ll learn how to keep your neck safe while you lift and carry items and as you begin to do other heavier activities. 治疗师与您一起设法活动和运动。这种治疗形式，被称为人体力学，用于帮助您养成新的活动习惯。当您开始工作和日常活动时，这种训练帮助您保持脖子在安全的位置。您将学到，抬重物并携带物品时，开始从事其他更重的活动时，如何保持您的脖子安全。
As your condition improves, your therapist will begin tailoring your program to help prepare you to go back to work. Some patients are not able to go back to a previous job that requires heavy and strenuous tasks. Your therapist may suggest changes in job tasks that enable you to go back to your previous job. Your therapist can also provide ideas for alternate forms of work. You’ll learn to do your tasks in ways that keep your neck safe and free of extra strain. 随着病情的改善，治疗师将开始调整计划，以帮助您作好回去工作的准备。一些患者无法回到以前那种需要繁重和艰巨任务的工作。治疗师可能建议改变工作任务，以恢复以前的工作。治疗师还可以提供其他点子来改变干活的方法。从中您将学到干活的正确方式，以保持脖子的安全，避免额外的用力。
Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems. 在您的治疗结束之前，治疗师将教会您一些方法，以避免将来可能发生的问题。 （滕红林 译） 滕红林，男，主任医师，脊柱外科博士，温州医学院附属第一医院脊柱外科负责人，科室副主任，硕士生导师。任中国抗癌协会脊柱肿瘤学组委员、浙江省骨科学会脊柱外科学组委员、浙江省康复医学会脊柱脊髓损伤协会委员、浙江省老年学学会脊柱关节病专业组委员、中华医学会数字医学分会青年委员、温州医学院中青年学科带头人（脊柱外科）和《脊柱外科杂志》编委。 1996年本科毕业于温州医学院医学系，同年分配至温医一院骨科工作。1999年~2004年在上海第二军医大学长征医院脊柱外科专业攻读临床型硕士、博士。师从上海长征医院脊柱外科专家贾连顺教授。毕业回院后先后赴欧洲荷兰VU大学脊柱肿瘤中心、美国西雅图脊柱微创中心、美国双子城脊柱中心、美国Anderson脊柱肿瘤中心等进修学习脊柱外科微创、脊柱肿瘤和畸形等。2005年初负责并在创立了脊柱外科专业。擅长上颈椎和颈椎手术、脊柱骨折、脊髓损伤、脊柱骨质疏松骨折、脊柱骨肿瘤、脊柱侧凸和后凸畸形矫形等手术。 副主译《麦氏腰背痛》;参编《脊柱肿瘤外科学》并担任学术秘书;另参编、编译脊柱外科专业书籍10余本，如《枕颈部外科学》、《颈椎外科手术图谱》、《颈椎外科学》、《腰椎外科学》、《脊柱创伤外科学》、《脊柱内镜手术学》、《脊柱微创外科学》和《微创脊柱学》等。发表国外SCI论文10多篇，其中第1作者及通讯作者共5篇。2009年关于如何选择颈胸段脊柱手术入路的论文发表在《Journal of Neurosurgery: Spine》，2011年关于脊柱骨肿瘤的论文发表在国际脊柱外科界的权威杂志《Spine》杂志上。参与脊柱骨肿瘤的课题，2004年获得上海市科技进步二等奖(第5)、军队医疗成果二等奖和中华医学科技奖三等奖1项。负责或参加国家级、省部级课题和军队课题5项。 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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