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 Introduction介绍A corpectomy is surgery to relieve pressure on the spinal cord due to spinal stenosis. In spinal stenosis, bone spurs press against the spinal cord, leading to a condition called myelopathy. This can produce problems with the bowels and bladder and disrupt the way you walk. Fine motor skills of the hand may also be impaired. In a corpectomy, the front part of the spinal column is removed. (Corpus means body, and ectomy means remove.) Bone grafts are used to fill in the space. This procedure is used when bone spurs have developed in more than one vertebra. 颈椎椎体的次全切术用于对椎管狭窄导致的脊髓压迫减压。在椎管狭窄时，由于骨刺压迫脊髓导致脊髓病。这会影响大小便功能和行走功能，同时手的精细运动也会受到影响。在椎体次全切除术中，前面一部分的椎体被切除（corpus表示椎体，ectomy表示切除）。切除后的空间由植骨块来填充。当不止一个节段颈椎受到骨刺影响时可使用本手术。 This guide will help you understand · what part of the spinal column is affected · why the procedure becomes necessary · what happens before and during the operation · what to expect as you recover 这篇指南旨在帮助你了解：
Anatomy解剖 What parts of the neck are involved? 涉及到哪些颈部的结构？ Surgeons perform this procedure through the front of the neck. This is known as the anterior neck region. Key structures include ligaments, bones, intervertebral discs, the spinal cord and spinal nerves. 外科医生从病人颈前进行手术，也就是大家熟知的颈前区。关键的结构包括韧带、骨、椎间盘、脊髓和脊神经。
Related Document: A Patient’s Guide to Cervical Spine Anatomy 相关文献：颈椎解剖患者指南 Rationale基础理论What do surgeons hope to achieve? 外科医生的手术预期？ Spinal stenosis occurs when bone spurs project into the spinal column and press against the spinal cord. Removing the vertebral bodies along the front section of the spinal column gives surgeons a way to relieve pressure on the front surface of the spinal cord, reducing or eliminating the symptoms caused by the bone spurs. 当骨刺增生压迫脊髓，就导致了椎管狭窄。切除前面一部分的椎体可以解除脊髓前部的压迫，减轻或解除由于骨刺压迫导致的症状。 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, you need to take several steps. 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，你需要进行以下几个步骤。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在术前良好的身体条件。 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? 手术当中会发生哪些事情呢？ Patients are given a general anesthesia to put them to sleep during most spine surgeries. As you sleep, your breathing may be assisted with a ventilator. A ventilator is a device that controls and monitors the flow of air to the lungs. 大多数的病人的脊柱手术都会需要全身麻醉。全麻中，用呼吸机来帮助呼吸。呼吸机会控制和监测进入肺部的空气流量。 The surgeon starts by making an incision up the left side of the neck to the ear and then under the jaw to the bottom of the chin. The skin flap is opened to expose the structures of the neck. Retractors are used to separate and hold the muscles and soft tissues apart so the surgeon can work on the front of the spine. 首先术者在颈部左侧，从耳经腭到下巴下方的连线上作一切口。掀开皮瓣暴露颈部的结构。分离肌肉和软组织并用牵开器维持，以便术者可以在脊柱前方操作。 Special instruments are attached either to the skull or the spinal bones to stretch the neck with mild traction. The traction pull spreads the neck joints apart to give the surgeon more room to work. It also takes additional pressure off the spinal cord. Then the surgeon inserts a needle into the disc and does an X-ray to locate the exact sections where the bones are to be removed. 用特殊的设备固定颅骨或脊椎骨，使用轻柔的牵拉使颈椎伸展。牵引将颈椎间关节伸展开来，使术者有更多空间便于操作。牵引同时可减少致压物对脊髓的压力。然后术者在椎间盘中插入定位针后进行X射线透视来确定要切除的椎体的范围。 The surgeon carefully cuts part of the anterior longitudinal ligament away from the front section of the spinal column. Instruments are then used to take out the front half of the discs that lie between the vertebral bodies. Next, a small rotary cutting tool (a burr) is used to carefully remove the back half of the discs (called discectomy) and a row of vertebral bodies (called corpectomy). The ring of bone that surrounds and protects the spinal column isn’t touched. 术者仔细的将部分前纵韧带从颈椎的前部离断。然后用器械取出前半部分椎间盘。然后，用小号的旋切工具（磨钻）仔细切除椎间盘的后半部分（称为椎间盘切除术）和一排椎体（称为椎体次全切除术）。保护脊髓的环形骨头不用处理。 When the discs and vertebral bodies are out of the way, the posterior longitudinal ligament can be seen where it covers the front of the spinal cord. This thin ligament is shaved to remove areas that have hardened or buckled, as these areas are known to add pressure to the spinal cord. 当椎体和椎间盘切除后，可以看到覆盖在脊髓前部的后纵韧带。将这层薄薄的韧带切除，并去除压迫脊髓的坚硬和变形的组织。
The surgeon then prepares a bone graft that will fill in the space where the discs and vertebral bodies have been removed. A section of bone is taken from the fibula, the thin bone that runs along the outside of the lower leg. (The main bone of the lower leg is called the tibia.) Some surgeons prefer to take bone from the pelvis instead of the fibula. 然后术者准备一段移植骨用来填充被切除的椎体和椎间盘的区域。这段骨组织可以取自腓骨，即小腿的外侧的较细骨头。（小腿的主骨称为胫骨）。有些手术者喜欢从骨盆上取骨，而非腓骨。 Before inserting the bone graft, the surgeon increases the traction pull on the neck to help separate the space even more. The bone graft is sized to fill the full length of the removed section of bone and discs from one end to the other. 植骨之前，术者增加颈部的牵引力量以便使植骨空间更大。移植骨修剪成合适大小，以便正好从头到尾充填被切除的椎体和椎间盘的长度。
The section of bone is grafted into the space where the vertebral bones have been taken out. The graft acts like a supportive column, or strut, to support the elongated space and to prevent the neck from buckling forward. Your surgeon may attach a metal plate along the front of the spine to help lock the new graft in place. 部分的骨骼被移植到被切除的椎体的空间里。移植骨就像一个支撑柱，充填这个延长的空间，并防止颈部向前屈曲。你的外科医生会在脊柱的前部贴附一块金属板，用来帮忙固定移植骨的位置。 Another X-ray is taken to check the position of the graft. Then the muscles and soft tissues are put back in place, and the skin is stitched together. Patients are often placed in a rigid neck brace for at least three months to hold the neck still while the bones grow together, or fuse. 再次用X线检查移植骨的位置。然后将肌肉和软组织复位，并缝合皮肤。病人通常需要佩戴至少3个月的颈托来固定颈部的位置以保证骨质的愈合。 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
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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