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Neck Pain 颈痛 A Patient’s Guide to Neck Pain颈痛患者指南 Symptoms症状 What are some of the symptoms of neck problems? 颈椎疾病可引起什么症状？ Symptoms from neck problems vary. They depend on your condition and which neck structures are affected. Some of the more common symptoms of neck problems are 颈椎疾病的症状因人而异。取决于你的病情和哪部分颈椎结构受累。颈椎疾病最见的症状有： · neck pain · headaches · pain spreading into the upper back or down the arm · neck stiffness and reduced range of motion · muscle weakness in the shoulder, arm, or hand · sensory changes (numbness, prickling, or tingling) in the forearm, hand, or fingers
Diagnosis诊断 How will my doctor find out what is causing my problem? 我的医生该如何找到我的病因？ The diagnosis of neck problems begins with a thorough history of your condition. You might be asked to fill out a questionnaire describing your neck problems. Then your doctor will ask you questions to find out when you first started having problems, what makes your symptoms worse or better, and how the symptoms affect your daily activity. Your answers will help guide the physical examination. 颈椎疾病的诊断始于详细的病史。医生会让你填写调查表来描述你颈部的问题。医生会询问你什么时候开始出现问题，何种因素可加重或减轻症状，你的症状对你日常生活的影响。你的回答有助于指引进一步体格检查。 Your doctor will then physically examine the muscles and joints of your neck. It is important that your doctor see how your neck is aligned, how it moves, and exactly where it hurts. 然后医生就对你颈部肌肉和关节进行体格检查。医生会观察你颈椎如何排列、如何活动，以及具体什么部位疼痛，这些都很重要。 Your doctor may do some simple tests to check the function of the nerves. These tests measure your arm and hand strength, check your reflexes, and help determine whether you have numbness in your arms, hands, or fingers. 医生会做些简单的试验来检查神经功能。这些试验测量你胳膊和手的力量，检查反射以及确定麻木在你的胳膊、手还是手指。 The information from your medical history and physical examination will help your doctor decide which tests to run. The tests give different types of information. 你的病史信息和体格检查结果有助于你的医生决定需要做什么检查。这些检查能提供不同类型的信息。 Radiological Imaging放射检查 Radiological imaging tests help your doctor see the anatomy of your spine. There are several kinds of imaging tests. 放射学检查有助于医生观察你的脊柱的解剖。影像检查有许多种类。 X-rays X线 X-rays show problems with bones, such as infection, bone tumors, or fractures. X-rays of the spine also can give your doctor information about how much degeneration has occurred in the spine, by showing the amount of space in the neural foramina and between the discs. X-rays are usually the first test ordered before any of the more specialized tests. Special X-rays called flexion andextension X-rays may help to determine if there is instability between vertebrae. These X-rays are taken from the side as you lean as far forward and then as far backward as you can. Comparing the two X-rays allows the doctor to see how much motion occurs between each spinal segment. X线可显示骨的病变，比如感染、骨肿瘤或骨折。脊柱的X线片通过显示椎间孔和椎间盘的空间大小，为医生提供信息明确你的脊柱发生退变的程度。在更多的特殊检查之前，医生通常会要求X线检查。称为伸屈位X线的特殊X线检查有助于明确椎体间是否存在不稳。这是在你最大伸展位及最大屈曲位时从侧面进行的X线照相。医生通过对比这两张X线照片，能够了解每个脊柱节段间发生了多少的活动。 MRI 磁共振 The magnetic resonance imaging (MRI) scan uses magnetic waves to create pictures of the cervical spine in slices. The MRI scan shows the cervical spine bones, as well as the soft tissue structures such as the discs, joints, and nerves. 核磁共振成像（MRI）扫描利用磁波对颈椎进行检查并分层生成图像。磁共振扫描不仅能显示颈椎骨的图像，还能显示软组织结构，比如椎间盘、关节和神经。 MRI scans are painless and don’t require needles or dye. The MRI scan has become the most common test to look at the cervical spine after X-rays have been taken. 磁共振扫描是无痛的，也不需要穿刺或造影。进行X线检查后，磁共振扫描成为观察颈椎常用的检查。 CT scan CT扫描 The computed tomography (CT) scan is a special type of X-ray that lets doctors see slices of bone tissue. The machine uses a computer and X-rays to create these slices. It is used primarily when problems are suspected in the bones. 计算机辅助断层成像扫描（CT）是特殊类型的X线检查，使医生可以分层观察骨组织。机器使用计算机和X线来生成分层的图像。主要用于怀疑骨组织有病变时。 Myelogram 脊髓造影 The myelogram is a special kind of X-ray test where a special dye is injected into the spinal sac. The dye shows up on an X-ray. It helps a doctor see if there is a herniated disc, pressure on the spinal cord or spinal nerves, or a spinal tumor. Before the CT scan and the MRI scan were developed, the myelogram was the only test that doctors had to look for a herniated disc. The myelogram is still used today but not nearly as often. The myelogram is usually combined with CT scan to give more detail. 脊髓造影是一种特殊类型的X线检查，需要将特殊的造影剂注入神经囊内。造影剂在X线下可显影。脊髓造影有助于医生发现椎间盘疝出、脊髓或脊神经的压迫或脊柱肿瘤。在CT扫描和MRI扫描研制之前，脊髓造影是外科医生发现椎间盘疝出的唯一检查。脊髓造影至今仍在使用，但不象以往那样普遍。脊髓造影往往与CT扫描相结合以发现更多的细节。
Bone Scan 骨扫描 A bone scan is a special test where radioactive tracers are injected into your blood stream. The tracers then show up on special X-rays of your neck. The tracers build up in areas where bone is undergoing a rapid repair process, such as a healing fracture or the area surrounding an infection or tumor. Usually the bone scan is used to locate the problem, and other tests such as the CT scan or MRI scan are then used to look at the area in detail. 骨扫描是将放射性示踪剂注入到人体血管中的一种特殊的检查。示踪剂在特殊的X线上显示颈椎图像。当骨组织正在进行快速的修复过程，例如骨折愈合时或炎症或肿瘤周围，示踪剂构出图像。通常骨扫描用于病变的定位，然后再用其他检查比如CT或MRI扫描来细致地观察这个部位。
Other Tests其他检查 Your doctor may also ask you to have other tests done. 你的医生可能还会让你做其他的检查。 Electromyogram 肌电图 An electromyogram (EMG) is a special test used to determine if there are problems with any of the nerves going to the upper limbs. EMGs are usually done to determine whether the nerve roots have been pinched by a herniated disc. During the test, small needles are placed into certain muscles that are supplied by each nerve root. If there has been a change in the function of the nerve, the muscle will send off different types of electrical signals. The EMG test reads these signals and can help determine which nerve root is involved. 肌电图是用于明确是否有支配上肢的神经出现了病变。肌电图常用于明确神经根是否被疝出的椎间盘挤压。检查时，在每根神经根支配的特定肌肉内插入细针，如果神经功能有改变，肌肉或传递不同类型的电信号。通过阅读肌电图检查中这些信号，有助于明确哪根神经根受累。 Laboratory Tests 实验室检查 Not all causes of neck pain are from degenerative conditions. Doctors use blood tests to identify other conditions, such as arthritis or infection. Other tests may be needed to rule out problems that do not involve the spine. 颈痛并不都是由退行性疾病所引起。医生用血液检查来鉴别其他疾病，例如关节炎或感染。可能需要其他检查来排除脊柱以外的病变。 Treatment治疗 What can be done to relieve my symptoms? 怎样来缓解我的症状？ Nonsurgical Treatment非手术治疗 Whenever possible, doctors prefer to use treatments other than surgery. The first goal of these nonsurgical treatments is to ease your pain and other symptoms. 只要有可能，医生宁愿采取手术以外的治疗措施。非手术治疗的首要目标是减轻你的疼痛和其他症状。 Your health care providers will work with you to improve your neck movement and strength. They will also encourage healthy body alignment and posture. These steps are designed to slow the degeneration process and enable you to get back to your normal activities. 你的医务人员会与你一起改善你颈部的活动和力量。他们会鼓励健康的身体位置和姿势。这些做法的目的是减缓退变进程，使你恢复平常的活动。 Medications 药物 Many different types of medications are typically prescribed to help gain control of the symptoms of neck pain. There is no medication that will cure neck pain. Your doctor may prescribe medications to ease pain, fight inflammation, and to help you get a better night’s sleep. 通常，许多不同类型的处方药物可用于控制颈痛的症状。没有药物能够治愈颈痛，你的医生处方用药以缓解疼痛、抗炎和帮助你改善睡眠。 Soft Neck Collar 柔软的颈围 If your pain is severe, your doctor may recommend a soft neck collar to keep your neck still for short periods of time. Resting the muscles and joints can help calm pain, inflammation, and muscle spasm. 如果疼痛剧烈，医生会建议使用柔软的颈围来短时间保持你颈部静息。肌肉和关节的休息有助于缓解疼痛、炎症和肌肉痉挛。 Ice and Heat Applications 冰敷和热敷 You might also be advised to place a cold pack on your neck for 10 to 15 minutes at a time, or you may be shown how to do a contrast treatment. Contrast treatments involve switching between a cold pack and a hot pack. 医生还会建议你在颈部放置冰袋，每次10~15分钟。有时医生也会向你演示如何做对比治疗。对比治疗是在放冷敷袋和热敷袋之间轮换。 Physical Therapy 物理治疗 Some doctors ask their patients to work with a physical therapist. Therapy treatments focus on relieving pain, improving neck movement, and fostering healthy posture. A therapist can design a rehabilitation program to address your particular condition and to help you prevent future problems. 医生常让病人跟着理疗师做。物理治疗聚焦于缓解疼痛，改善颈部的活动并养成健康的姿势。治疗师会为特定的病情设计一套康复练习并帮助病人预防今后再出现问题。 Injections 注射 Spinal injections are used for both treatment and diagnostic purposes. There are several different types of spinal injections that your doctor may suggest. These injections usually use a mixture of an anesthetic and some type of cortisonepreparation. The anesthetic is a medication that numbs the area where it is injected. If the injection takes away your pain immediately, this gives your doctor important information suggesting that the injected area is indeed the source of your pain. The cortisone decreases inflammation and can reduce the pain from an inflamed nerve or joint for a prolonged period of time. 脊髓注射既可用于诊断也可用于治疗。你的医生可能建议多个不同类型的脊髓注射方法。通常使用麻醉药物和某些种类的可的松制剂混合药进行注射。麻醉药物是一种使注射部位出现麻木的药物。如果注射后疼痛即刻缓解，给你的医生提供重要的信息提示注射部位确实是疼痛的根源。可的松减轻炎症并可长时间缓解神经或关节炎症所引起的疼痛。 Some injections are more difficult to perform and require the use of afluoroscope. A fluoroscope is a special type of X-ray that allows the doctor to see an X-ray picture continuously on a TV screen. The fluoroscope is used to guide the needle into the correct place before the injection is given. 有些注射操作较困难，需要使用透视。透视是一种特殊类型的X线，允许医生在电视屏幕上连续观察X线图象。透视用于引导针穿到正确的位置后再进行注射。
硬膜外激素注射（ESI）：颈痛或疼痛向胳膊放射可用硬膜外激素注射（ESI）治疗。它是将混合药物注入神经根周围的硬膜外腔。通常，仅在其它非手术治疗无效时使用。硬膜外激素注射并不都能缓解疼痛。如果起效，也只短时间缓解疼痛。 相关视频：颈椎硬膜外注射 Selective Nerve Root Injection: Another type of injection to place steroid medication around a specific inflamed nerve root is called a selective nerve root injection. The fluoroscope is used to guide a needle directly to the painful spinal nerve. The nerve root is then bathed with the medication. Some doctors believe this procedure gets more medication to the painful spot. In difficult cases, the selective nerve root injection can also help surgeons decide which nerve root is causing the problem before surgery is planned. 选择性神经根注射：另一种将激素药物注入到特定的发炎的神经根周围的注射方法称为选择性神经根注射。透视用于引导穿刺针直接到达引起疼痛的神经根旁进行注射，这样神经根就完全浸泡于药液中。有些医生相信，这种方法可以使更多的药物到达痛点。在一些疑难病例，选择性神经根注射可帮助外科医生在术前计划制定前确定是哪根神经引起的症状。 相关视频：选择性颈椎神经根阻滞术 Facet Joint Injection: When the problem is thought to be in the facet joints, an injection into one or more facet joints can help determine which joints are causing the problem and ease the pain as well. The fluoroscope is used to guide a needle directly into the facet joint. The facet joint is then filled with medication mixture. If the injection immediately eases the pain, it helps confirm that the facet joint is a source of pain. The steroid medication will reduce the inflammation in the joint over a period of days and may reduce or eliminate your neck pain. 关节突关节注射：如果考虑症状由关节突关节引起，进行一个或多次关节突关节注射可明确是哪个关节突关节出了问题，同时可以缓解疼痛。用透视来引导穿刺针直达关节突关节，然后在关节突关节处注射混合药物。如果注射后疼痛即刻缓解，可以明确这个关节突关节是疼痛的根源。激素药物能在数日内减轻关节突关节的炎症并能够减轻或消除颈痛。 相关视频：颈椎关节突神经射频消融术 Trigger Point Injections: Injections of anesthetic medications mixed with a cortisone medication are sometimes given in the muscles, ligaments, or other soft tissues near the spine. These injections are called trigger point injections. These injections can help relieve neck pain and ease muscle spasm and tender points in the neck muscles. 触发点注射：麻醉剂和激素的混合注射液有时可注入脊柱旁边的肌肉、韧带或其他软组织。这种注射称为触发点注射，可以缓解颈痛，解除肌肉痉挛以及颈部肌肉的压痛点。 Surgery手术 Only rarely is cervical spine surgery scheduled immediately. Your doctor may suggest immediate surgery if there are signs of pressure developing on the spinal cord or if your muscles are becoming weaker very rapidly. 只有很少的颈椎疾病需要立即手术。如果出现脊髓受压的征象或肌无力进展迅速，医生会建议急诊手术。 For other conditions, doctors prefer to try nonsurgical treatments for a minimum of three months before considering surgical options. Most people with neck pain tend to get better, not worse. Even people who have degenerative spine changes tend to gradually improve with time. Surgery may be suggested when severe pain is not improving. 除此之外，医生更倾向于尝试至少3个月的保守治疗。大部分颈痛患者能够缓解，而非加重。甚至那些已经发生脊柱退行性改变的患者通常会随着时间而改善。如果严重的疼痛不缓解，医生可能会建议手术治疗。 There are many different operations for neck pain. The goal of nearly all spine operations is to remove pressure from the nerves of the spine, to stop excessive motion between two or more vertebrae, or both. 颈痛的手术方式很多。几乎所有的脊柱手术的目的在于解除脊神经的压迫，阻止椎体间过度的活动。 The type of surgery that is best depends on the patient’s conditions and symptoms. 手术方式由患者的病情及症状而定。 椎间孔扩大成形术
椎间孔扩大成形术是打开椎间孔，解除脊神经根的压迫。因为骨刺或炎症也可做椎间孔扩大成形术。 Related Document: A Patient’s Guide to Cervical Foraminotomy 相关阅读：颈椎椎间孔扩大术患者指南（翻译招募中，有意者请留言） 椎板切除术
椎板是椎管骨环的后盖，在脊柱后方形成屋顶一样的结构。当椎管内的神经受到疝出的椎间盘或伸入椎管的骨刺挤压，椎板切除术可去除部分或全部的椎板来减轻脊神经的压迫。 Related Document: A Patient’s Guide to Laminectomy 相关阅读：椎板切除术患者指南（翻译招募中，有意者请留言） 椎间盘切除术 In a discectomy, the surgeon removes a problem disc. Surgeons usually do this surgery from the front of the neck. This procedure is called anterior cervical discectomy. In most patients, discectomy is done together with a procedure called cervical fusion (described next). 在椎间盘切除术中，外科医生将病变椎间盘去除。外科医生通常从前方做这种手术，此称为前路颈椎间盘切除术。在很多病人，做椎间盘切除的同时会做一个称为颈椎融合术（后述）的手术。 Related Document: A Patient’s Guide to Cervical Discectomy Cervical Fusion 颈椎融合术 A fusion surgery joins two or more bones into one solid bone. The purpose for doing spinal fusion is to increase the space between the vertebrae and to keep the sore joint from moving. This is usually done by placing a small block of bone graft in the space where a disc was removed. Opening up more space enlarges the neural foramen, takes pressure off the nerve roots, and eases tension on the facet joints. Cervical fusion is used to treat neck problems such as cervical radiculopathy, disc herniations, fractures, and spinal instability. There are two main types of fusion for neck problems. 融合术将两块或多块骨连成一块牢固的骨。脊椎融合术的目的是增加椎间隙高度，防止疼痛关节的活动。通常在椎间盘切除留下的空间植入一小块骨移植物。椎间隙增加使椎间孔扩大，解除了神经根的压力，缓解了关节突关节的紧张。颈椎融合术用于治疗诸如神经根型颈椎病、椎间盘出、骨折、脊椎不稳等颈椎疾患。颈椎疾患主要有两种融合方式。 Anterior Discectomy and Fusion: 前路椎间盘切除融合
前路椎间盘切除融合术通过颈前方进行。当椎间盘切除的，留下的空间由小块骨移植物来填充。骨可以愈合，将两个椎体融合成一个坚硬的骨头。 Related Document: A Patient’s Guide to Anterior Cervical Discectomy and Fusion 相关阅读：前路颈椎间盘切除融合术患者指南（翻译招募中，有意者请留言）
相关视频：颈前路椎间盘切除融合术 后路融合 In posterior fusion, the surgeon lays small grafts of bone over the back of the spine. When these bones heal together, they fuse the two vertebrae into one solid bone. Posterior fusions in the cervical spine are primarily used to treat fractures of the neck. 在后路融合术中，外科医生将小块的骨移植物放置于脊柱的后方。当骨愈合在一起时，将两个椎体融合成一个整体。后路融合在颈椎主要是用于治疗颈椎骨折。 Related Document: A Patient’s Guide to Posterior Cervical Fusion 相关阅读：后路颈椎融合术患者指南（翻译招募中，有意者请留言）
为了融合成功，骨移植物需要时间来愈合。这需要颈部保持静止。在颈椎融合术后，病人通常需要佩带特殊的颈椎支具数月。这些颈椎支具既笨重又限制活动。近来，外科医生开始使用金属板和螺钉（通常称作内植物）将骨组织固定在一起。内植物将脊椎骨固定，在骨移植物愈合过程中保持骨静止不动。 Corpectomy and Strut Graft 椎体次全切除和支撑植骨 A corpectomy relieves pressure over a large part of the spinal cord. In this procedure, the surgeon takes off the front part of the spinal column and removes several vertebral bodies. The spaces are then filled with bone graft material. Metal plates and screws are generally used to hold the spine in place while it heals. A corpectomy is used in cases of severe spinal stenosis and myelopathy. 椎体次全切除解除大段脊髓的压力。术中，外科医生将脊柱前方部分去除，并切除数个椎体，然后用骨移植材料填充，在骨愈合过程中，常使用金属板和螺钉将脊柱固定。椎体次全切除常用于严重椎管狭窄和脊髓型颈椎病病例。 Related Document: A Patient’s Guide to Cervical Corpectomy and Strut Graft 相关阅读： 英汉对照骨科患者指南005：颈椎椎体次全切除植骨术患者指南（上）英汉对照骨科患者指南005：颈椎椎体次全切除植骨术患者指南（下） 相关视频：颈前路椎体次全切除术 Rehabilitation康复 What should I expect after treatment? 治疗结束后我还需要做什么？ Nonsurgical Rehabilitation非手术治疗的康复
非手术治疗可最大程度恢复你颈椎的健康，推迟可能需要的手术时间。对于颈痛患者通常需要进行2~4周的理疗。治疗方法精心设计，目的在于减轻疼痛，增加你的活动能力、力量，改善姿势和功能。理疗师还会教你如何控制症状，在今后如何保护好颈椎。你可能需要定期做些练习。 After Surgery术后康复 Rehabilitation after surgery is much more complex. Some patients leave the hospital shortly after surgery, but some surgeries require patients to stay in the hospital for a few days. Patients who stay in the hospital may visit with a physical therapist in the hospital room soon after surgery. The treatment sessions help patients learn to move and do routine activities without putting extra strain on the neck. 术后康复更加复杂。有些病人可能在术后短时间内就出院了。对于有些手术，需要在医院呆几天。当病人住院期间，理疗师会在术后很快来你的病房会诊。理疗阶段帮助你学习如何活动和做日常活动，而不对颈椎增加额外的应力。 Many surgical patients need physical therapy outside of the hospital as well. They often see a therapist for one to three months, depending on the type of surgery. Therapy treatments are designed to calm pain and muscle spasm, teach patients to move safely, and help patients develop strength and mobility. 有些手术病人出院后仍旧需要物理治疗。他们通常在1~3月内去找理疗师，取决于何种类型的手术。物理治疗精心设计用于缓解疼痛和肌肉痉挛，教病人安全地移动，帮助病人增强力量和活动能力。 As the therapy sessions come to an end, the therapist may help the patient get back to work. The therapist can do a work assessment to ensure the patient can do his or her job safely. Some patients may need to modify their work or other activities to avoid future problems. 在物理治疗的最后阶段，理疗师会帮助病人重返工作岗位。理疗师会做工作评估来确保病人可以安全地工作。有些病人需要更换工作和其他活动，以避免今后的问题。 （胡佰文 译） |
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