Cervical Spinal Stenosis颈椎管狭窄 A Patient’s Guide to Cervical Spinal Stenosis颈椎管狭窄患者指南
Introduction引言
脊髓是一束被脊柱里的骨性管道保护着的神经组织。任何使管道变窄的疾患都将增加脊髓被挤压的风险。颈部椎管的狭窄即为颈椎管狭窄。由椎管狭窄导致的脊髓受压即为脊髓病，脊髓病会影响大小便功能、改变走路方式以及影响精细动作, 这种情况下需要就医诊治。 This guide will help you understand · what parts make up the spine and neck · what causes cervical spinal stenosis · how the condition is diagnosed · what treatment options are available 本指南将帮助您了解： ● 脊柱和颈椎的组成 ● 颈椎管狭窄的病因 ● 颈椎管狭窄的诊断 ● 颈椎管狭窄的治疗
解剖What parts make up the spine and neck? 脊柱和颈椎由哪些部分组成？ The spine is made of a column of bones. Each bone, or vertebra, is formed by a round block of bone, called a vertebral body. A bony ring attaches to the back of the vertebral body, forming a canal. 脊柱由柱状排列的骨头组成， 每一块骨头由一块圆柱形骨头组成，又名椎体。椎体后缘附着着骨环，一起形成一个椎管。 This bony ring is formed by two sets of bones. One set, the pedicle bones, attaches to the back of each vertebral body. 骨环由两部分骨头形成。与每块椎体的后部相连的那部分是椎弓根。
在椎弓根另一端则连接着椎板。椎板在脊髓后方形成了一个保护性的顶盖。当椎骨相互堆叠的时候，上述骨环形成长长的骨性管道，保护着在其内通过的脊髓。 An intervertebral disc fits between each vertebral body and provides a space between the spine bones. The disc works like a shock absorber. It protects the spine against the daily pull of gravity. It also protects the spine during activities that put strong force on the spine, such as jumping, running, and lifting. 椎间盘连接在每块椎骨之间，将脊椎骨隔开。椎间盘就像个减震器，帮助脊柱对抗重力牵引；并且在日常活动如跑跳和提物品中保护脊柱抵抗强大的压力。
椎间盘由两个部分组成。中间部分叫做髓核，富有弹性，起着减震器的主要作用。髓核外面环绕着纤维环，这是一系列环绕在髓核周围的坚强的韧带环。韧带是坚韧的结缔组织，将骨与骨之间附着在一起。 Related Document: A Patient’s Guide to Cervical Spine Anatomy 相关阅读：英汉对照骨科患者指南015：颈椎解剖 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》 Causes病因 Why do I have this problem? 这个毛病是怎么引起的？ The bony spinal canal normally has more than enough room for the spinal cord. Typically, the canal is 17 to 18 millimeters around, slightly less than the size of a penny. Spinal stenosis occurs when the canal narrows to 13 millimeters or less. When the size drops to 10 millimeters, severe symptoms of myelopathy occur.Myelopathy is a term for any condition that affects the spinal cord. The symptoms of myelopathy result from pressure against the spinal cord and reduced blood supply in the spinal cord as a result of the pressure. 正常的椎管里有充足的空间容纳脊髓。一般椎管前后径在17到18mm左右，比一便士硬币稍微小一些。当椎管小于13mm时候，即为椎管狭窄。当椎管小于10mm时，将会发生严重的脊髓病。任何使脊髓发生病变的情况都称脊髓病。当脊髓受压和脊髓血供受限时都将产生脊髓病的症状。 Spinal stenosis may develop for any number of reasons. Some of the more common causes of spinal stenosis include 椎管狭窄的病因有很多，最常见的有以下几种： · congenital stenosis · degeneration · spinal instability · constriction of the blood supply to the spinal cord ● 先天性椎管狭窄 ● 脊柱退变 ● 脊柱不稳 ● 椎间盘突出 ● 脊髓血供受限 Congenital Stenosis先天性椎管狭窄Some people are born with a spinal canal that is narrower than normal. This is called congenital stenosis. They may not feel problems early in life, but having a narrow canal to begin with places them at risk for stenosis. Even a minor neck injury can set them up to have pressure against the spinal cord. People born with a narrow spinal canal often have problems later in life, because the canal tends to become narrower due to the affects of aging. These degenerative changes often involve the formation of bone spurs (small bony projections) that point into the spinal canal and put pressure on the spinal cord. 有些人生来椎管就狭小，称为先天性椎管狭窄。早年的时候他们可能没有什么不适症状，但狭窄的椎管增加了发生脊髓压迫的风险。甚至是微小的颈部损伤也可能引起脊髓受压。先天性椎管狭窄患者的椎管随着年龄的增长会越来越狭窄，因此常常会在今后的人生中出现问题。这些退行性改变主要是指突向椎管的骨刺（微小的骨性突起），并且会挤压脊髓。 Degeneration脊柱退变
退行性变是椎管狭窄最常见的病因。由于脊柱的老化以及反复受力拉伤引起脊柱磨损和撕裂，会造成许多颈椎退变性病变。例如，椎间盘开始出现塌陷，会导致椎间隙变狭窄。有些骨刺生长会突向椎管，进而缩小容纳脊髓的空间。将诸椎体维系在一起的韧带会变厚并且突向椎管。所有上述退行性变都会使椎管变得狭窄。 Spinal instability脊柱不稳
Spinal instability can cause spinal stenosis. Spinal instability means there is extra movement among the bones of the spine. Instability in the cervical spine can happen if the supporting ligaments have been stretched or torn from a severe injury to the head or neck. People with diseases that loosen their connective tissues may also have spinal instability. For example, rheumatoid arthritis can cause the ligaments in the upper bones of the neck to loosen, allowing the topmost neck bones to shift and close off the spinal canal. Whatever the cause, extra movement in the bones of the spine can lead to spinal stenosis and myelopathy. 脊柱不稳也能导致椎管狭窄症。脊柱不稳是指脊柱的骨块的活动超过正常情况。头颈部严重的损伤导致的脊柱支持韧带的拉伸撕裂，将会导致颈椎不稳。患有使结缔组织松弛的疾病患者，也可能会产生脊柱不稳。例如，类风湿关节炎患者的上颈椎韧带会变得松弛，使得寰椎发生移动，进而占据了椎管的空间。总而言之，不管是哪种病因，脊柱骨头额外的移动都有可能导致椎管狭窄和脊髓病。 Disc herniation椎间盘突出
颈椎间盘的突出也能导致椎管狭窄。正常情况下，吸收震荡的椎间盘能够抵抗重力向下的压力和日常活动的牵拉。但是，如果椎间盘承受的压力过大超过椎间盘负荷的时候，比如来自头颈部的击打，将会导致纤维环的撕裂以及髓核从椎间盘中被挤出。这就是椎间盘突出。如果椎间盘直接往后突出，将会挤压脊髓并且发生椎管狭窄。
Constriction of the blood supply to the spinal cord脊髓血供受限 The changes that happen with degeneration and disc herniation can choke off the blood supply that goes to the spinal cord. The sections of the spinal cord that don’t get blood have less oxygen and don’t function normally, leading to symptoms of myelopathy. 脊柱退行性变以及椎间盘突出都将会导致脊髓血供的受限。失去血供的那部分脊髓不能得到充足的氧分，从而失去传导神经信号的功能，最终导致脊髓病的发生。 相关视频：颈椎管狭窄引起脊髓型颈椎病脊髓病（Myelopathy）Symptoms症状 What does cervical stenosis feel like? 颈椎管狭窄的症状有哪些？ Cervical stenosis usually develops slowly over a long period of time. This is partly because degeneration in later life is the main cause of spinal stenosis. Symptoms rarely appear all at once when degeneration is causing the problems. A severe injury or a herniated disc may cause symptoms to come on immediately. 颈椎管狭窄病情往往在很长一段时间里都发展缓慢。可能是因为中年以后的退行性变才是椎管狭窄的主要病因。当病因是退行性变的时候，症状一般不会立刻出现。而当病因是严重的损伤或者椎间盘突出时，症状往往立即出现。 The first sign to appear in some patients is a change in the way they walk. They don’t realize this problem is coming from their neck. But pressure on the spinal cord in the neck can affect the nerves and muscles in the legs, leading to changes in the way they walk. Eventually their walking pattern gets jerky and they lose muscle power in the legs. This is called spasticity. 大多数病人的第一个症状是走路方式的改变。患者并没有意识到这个问题来自颈椎。但是颈髓的受压会引起下肢神经和肌肉的反应，使得走路方式发生改变。最终患者走路变得呆滞，腿部肌肉变得无力。这即为痉挛状态。
Most patients also have problems in their hands. The main complaint is that their hands start to feel numb. Others feel clumsy when doing fine motor activities like writing or typing. The ability to grip and let go of items becomes difficult because the muscles along the inside edge of the palm and fingers weaken. 大多数病人手部也会出现症状。常听到的主诉是他们的手变得麻木。也有患者自诉当做精细运动如写字或打字时，手会变得笨拙。由于掌指肌肉力量减弱，手的抓握也变得困难。 Shoulder weakness also develops in many patients. This happens most often when the spinal cord is compressed in the upper part of the neck. Most affected are the shoulder blade muscles and the deltoid muscle, which covers the top and outside of the shoulder. These muscles weaken and begin to show signs of wasting (atrophy) from not getting nerve input. 当上颈髓被压迫时，患者常常会出现肩关节活动受限。最易受影响的是分布在肩关节上方和外侧的肩胛肌和三角肌。这些肌肉力量变弱，由于失去神经的支配，开始出现肌肉萎缩等征象。
颈椎管狭窄患者颈髓受压的位置与支配上肢的神经非常相近。引起颈髓受压的问题也会影响从脊柱离开的神经。神经受压会产生从颈部向肩部、上背部、甚至是单侧或双侧上肢的放射痛。而且会导致手臂或手部皮肤的麻木感以及相应神经支配区域肌肉力量的减弱。
Pressure against the spinal cord also creates problems with the bowels and bladder. Mild spinal cord pressure makes you feel like you have to urinate more often. But it also makes it difficult to get urine to flow (urinary hesitancy). Moderate disturbances cause people to have a weak flow of urine, making them dribble urine. They also have to strain during bowel movements. In severe cases, people aren’t able to voluntarily control their bladder or bowels. This is called incontinence. 脊髓的受压还会引起大小便功能的丧失。轻微的脊髓受压会有尿频的症状，并且每次都很难排尿（排尿不畅）。中度受压会使患者排尿困难，尿流滴沥。只有用力才能顺利排尿。如果是脊髓严重受压，患者不能自主控制大小便，即为大小便失禁。 Diagnosis诊断 How will my doctor identify the condition? 我的医生怎么诊断这个毛病？
Diagnosis begins with a complete history and physical exam. Your doctor will ask questions about your symptoms and how your problem is affecting your daily activities. This will include questions about pain, feelings of numbness or weakness, changes in bowel or bladder function, and whether you’ve noticed any changes in the way you walk. 诊断源自完整的病史和体格检查。你的医生会询问相应的症状以及这些症状对日常活动的影响。这些问题包括是否有疼痛、是否有麻木感或无力感、大小便功能以及走路方式是否有改变。 Then the doctor does a physical examination to see which neck movements cause pain or other symptoms. Your skin sensation, muscle strength, and reflexes are tested. Your doctor will also watch you walk to see if there are any subtle changes in your walking pattern. 然后医生会做一系列体格检查来确定哪些颈部活动会引起疼痛或其他症状。包括皮肤感觉、肌力以及反射的检查。之后你的医生会叫你在他面前走路来观察你走路方式是否发生微小的变化。
X线可用来观察脊髓受压的病因。X片可显示是否是退变引起的椎间隙的狭窄或者是否是骨刺的引起的脊髓受压。
如果你的医生想获取更多信息，他会建议做一个核磁共振（MRI）检查。MRI机器通过核磁共振波原理而非X射线来显示软组织。这个检查可以清楚显示脊髓以及脊髓受压的节段。核磁共振机器可以对你的医生感兴趣区域切片扫描。不仅如此，这种检查不需要任何特殊的造影剂和穿刺针，是一种无创检查。 A computed tomography (CT) scan may also be ordered. The CT scan is a detailed X-ray that lets doctors see slices of bone tissue. The image can show if bone spurs are protruding into the spinal column and taking up space around the spinal cord. 除X光和MRI外，CT扫描也是可以选择的一种影像学检查。CT扫描利用X线原理对医生感兴趣的骨组织区域进行切片。这种图像可以显示向椎管突出并占据脊髓周围空间的骨刺。
你的医生也可能会建议对支配你手臂和手的神经做电生理检查。肌电图（EMG）测试用来检查神经的电传导是否正常。医生也会建议你做躯体感觉诱发电位（SSEP）测定来检查具体哪块节段的脊髓受压。躯体感觉诱发电位（SSEP）可用来测试神经是否能够接收和传导如痛觉、温觉以及触觉这些感觉刺激。通过贴在皮肤表面的电极或者用电针插入神经或者是大脑的感觉中枢，神经的功能状态即可被记录下来。 （胡小坚 翻译 王跃 校对）
编辑：胡佰文 |
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