Cervical Corpectomy and Strut Graft颈椎椎体次全切除术和支撑植骨术 A Patient’s Guide to Cervical Corpectomy and Strut Graft
颈椎椎体次全切除术和支撑植骨术患者指南Complications并发症 What might go wrong? 会有什么并发症？ As with all major surgical procedures, complications can occur. Some of the most common complications following corpectomy surgery include 所有主要的外科手术，都可能出现并发症。椎体次全切除术的并发症主要包括以下几个方面： · problems with anesthesia · thrombophlebitis · infection · nerve damage · problems with the graft or hardware · nonunion · ongoing pain
This is not intended to be a complete list of the possible complications, but these are the most common. 这里没有列出所有可能发生的并发症，但这些是最常见的。 Problems with Anesthesia 麻醉风险 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. 手术过程中麻醉药品与病人服用的其他药物产生反应时，可能会出现问题。在罕见的情况下，病人会对麻醉药物本身产生反应。此外，麻醉会影响肺功能，因为麻醉时肺部不能像平时一样很好的扩张。一定要和麻醉师讨论麻醉风险及你所关注的问题。 Thrombophlebitis (Blood Clots) 血栓性静脉炎（凝血块） 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，有时被称为深静脉血栓，在任何一个手术之后都可能发生。当腿部的大静脉中血液形成凝血块时发生。它会导致腿部的肿胀，皮温升高和疼痛。如果凝血块从静脉中脱落，它可以转移到肺部，阻塞肺部的毛细血管，阻断一部分肺的血供。这被称为肺栓塞。绝大多数的外科医生都非常认真地预防下肢深静脉血栓。有很多的方法可降低发生下肢深静脉血栓的风险，但是最有效的方法是让你尽快的下床活动。另外两种常用的预防措施包括： · pressure stockings to keep the blood in the legs moving · medications that thin the blood and prevent blood clots from forming
Infection 感染 Infection following spine surgery is rare but can be a very serious complication. Some infections may show up very 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. Your surgeon may give you antibiotics before spine surgery when the procedure requires bone grafts or hardware (plates, rods, or screws). 脊柱术后的感染是非常少见的，但是一旦反生会导致很严重的并发症。有些感染会很早的表现出来，甚至是在你出院之前。皮肤表面的感染通常可以使用抗生素来治愈。脊柱深部累及到骨和软组织的感染很难被治愈，并可能需要额外的手术来治疗感染的脊柱部位。如果你的手术需要植骨或者内固定（钢板，棒或者螺钉），你的外科医生会在脊柱手术前会给你使用抗生素。 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. 靠近椎管的任何手术都有可能导致脊髓或者脊神经的损伤。在肿胀的神经组织周围，手术器械对神经的碰撞或者切断神经组织都会导致损伤的发生。这些结构的损伤会导致相应支配区域的肌肉萎缩和感觉的丧失。 The nerve to the voice box is sometimes injured during surgery on the front of the neck. Surgeons usually prefer to do surgery on the left side of the neck where the path of the nerve is more predictable than on the right side. During surgery, the nerve may be 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 in which the nerve is actually cut, patients may end up with ongoing minor problems of hoarseness, voice fatigue, or difficulty making high tones. 经前路的手术有时会损伤支配发声的神经。外科医生通常会选择从左侧的颈部而非右侧进行手术，因为左侧的神经走形更容易把握。手术过程中，肌肉和软组织被牵引器牵开使得神经被拉伸变长。当这种情况发生时，病人会在术后的几天或者几周内出现声音的嘶哑。在很少见的情况下，如果神经确实被切断，病人最终可能会一直有声音嘶哑、发音疲劳或者难以发出高音调的声音等小问题。 Problems with the Graft or Hardware 移植物或者内固定的问题 Corpectomy surgery requires bone to be grafted into the spinal column. The graft is taken from either the top rim of the pelvis or, more commonly, from the fibula bone along the outside of the lower leg. There is a risk of having pain, infection, or weakness in the area where the graft is taken. 椎体次全切除手术需要植骨来填充被切除的椎体的区域。移植骨通常选用骨盆顶部的边缘或者更常见的选用小腿外侧的腓骨。这会引起疼痛，感染，供区骨质被移除而薄弱的问题。 After the graft is placed, the surgeon checks the position of the graft before completing the surgery. However, the graft may shift slightly soon after surgery to the point it is no longer able to hold the spine stable. When the graft migrates out of position, it may cause injury to the nearby tissues. When the graft shifts out of place, a second surgery may be needed to align the graft and apply more hardware to hold it firmly in place. 移植术后，外科医生会在完成整个手术前确认移植骨的位置。然而，移植术后可能会有轻微的位置变化，这会使得移植骨不能保持脊柱的稳定。当移植骨偏离正确的位置，它会损伤周围的组织。当移植骨脱出时，需要二次手术来摆放移植骨的位置并使用更多的内固定将其牢牢地固定在正确的位置上。 Hardware can also cause problems. Screws or pins may loosen and irritate the nearby soft tissues. Also, the metal plates can sometimes break. The surgeon may suggest another surgery either to take out the hardware or to add more hardware to solve the problem. 内固定材料也会出现问题。螺钉或者针可能会松动然后会刺激周围的组织。同时，钢板有时候可能出现断裂。外科医生可能会建议再进行手术取出内固定或者增加更多的内固定来解决这些问题。
Nonunion 骨不连 Sometimes the bones do not fuse as planned. This is called anonunion, or pseudarthrosis. (The term pseudarthrosis means false joint.) If the joint motion from a nonunion continues to cause pain, you may need a second operation. 有时候骨折不象预期那样愈合。这被称为骨不连或者假关节（这个词意味着错误的关节）。如果骨不连的关节运动引起持续的疼痛，你可能需要进行二次手术。 In the second procedure, the surgeon usually adds more bone graft. If hardware was used in the first surgery, the surgeon will check to make sure it is attached firmly. Hardware may also be added to secure the bones so they will fuse together. 在二次手术中，外科医生通常增加移植骨的量。如果第一次手术使用内固定，外科医生会检查它以确保它固定在位。内固定同时会固定骨骼，使得它们融合在一起。 Ongoing Pain 持续的疼痛 Corpectomy is a complex surgery. Not all patients feel complete pain relief with this procedure. The main goal of this surgery is to get pressure off the spinal cord and to try and prevent further problems. As with any surgery, 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. 椎体次全切除术是一个复杂的手术。不是所有的病人都可以从此术式中解除痛苦。这个手术的主要目的是解除脊髓的压迫以及防止远期的症状出现。和其他手术一样，你会出现术后的疼痛。如果疼痛持续并且不能忍受，告诉你的外科医生，他会帮助你缓解你的疼痛。 After Surgery术后 What happens after surgery? 术后会发生什么？ Most patients are placed in a rigid neck brace or a halo vest, for a minimum of three months after surgery. These restrictive measures may not be needed if the surgeon attached metal hardware to the spine during the surgery. 大多数病人术后最少佩戴3个月的硬性颈托或者头颈胸背心。如果医生在术中使用了内固定材料，这些限制性的措施可能就不需要了。 Patients usually stay in the hospital after surgery for up to one week. During this time, a physical therapist will schedule daily sessions to help patients learn safe ways to move, dress, and do activities without putting extra strain on the neck. 病人术后通常住在医院一周。在此期间，物理治疗师会安排一个每日的日程来帮助病人安全的进行行走、起居以及不额外增加颈部压力的活动。 Patients are able to return home when their medical condition is stable. However, they are usually required to keep their activities to a minimum in order to give the graft time to heal. Outpatient physical therapy is usually started five weeks after the date of surgery. 当病人的情况稳定后就能出院回家。然而，他们通常需要限制活动以便移植骨的愈合。门诊的物理治疗通常是在术后5周开始的。
Rehabilitation康复 What should I expect during my recovery? 术后康复预期能达到怎样的目标？ Rehabilitation after corpectomy surgery can be a slow process. You will probably need to attend therapy sessions for two to three months, and you should expect full recovery to take up to one year. 椎体次全切除术后的康复是个漫长的过程。你可能需要2到3个月的治疗，完全康复需要1年的时间。 Many surgeons prescribe outpatient physical therapy beginning a minimum of five weeks after surgery. At first, 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. 许多的外科医生会在术后的5周开始门诊的物理治疗。首先，治疗会用于控制疼痛和炎症。冰敷和电刺激是有助于达到这些目标的常用治疗方法。你的治疗师可能也会使用按摩或者其他的治疗手法来缓解肌肉痉挛和疼痛。 Active treatments are slowly added. 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. 积极的治疗措施循序渐进。这些措施包括改善心肺功能的练习。步行、原地骑车和手臂自行车是理想的心血管运动方式。治疗师还会教你特殊的训练方式来帮助你的发音，控制你的肌肉以及稳定你的颈部和上背部。
Your therapist also 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. At first, this may be as simple as helping you learn how to move safely and easily in and out of bed, how to get dressed and undressed, and how to do some of your routine activities. Then you’ll learn how to keep your neck safe while you lift and carry items and as you begin to do other heavier activities. 你的治疗师会跟你一起工作教你如何行走和活动。这种形式的治疗，被称为人体力学，用来帮助你养成新的运动习惯。这些训练有助于你在工作和日常活动中使你的颈部在安全的位置上。首先，他可能会帮助你学会一些简单动作，比如怎样安全地上床和下床、穿衣和脱衣、以及怎样做一些日常活动。然后你会学习到在如何保证你的颈部安全下从事一些重的活动时候，比如拎起一些东西。 As your condition improves, your therapist will tailor 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. You’ll learn new ways to do these tasks to keep your neck safe and free of extra strain. 随着你状况的改善，你的治疗师会调整你的计划来帮助你回到工作中去。一些病人不能回到先前那种繁重和费力的工作中去。你的治疗师会建议改变一些工作任务，使得你能重新回到以前的工作岗位。你会学习到新的方法来完成这些任务以保证你颈部的安全，不带来额外的扭伤。 Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems. 在你的治疗日程结束前，你的治疗师会教会你一些方法来避免以后可能出现的问题。 翻译：周轶，医学硕士，南通市中医院工作（现在南通市一院参加住院医师规范化培训）。 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
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