英汉对照骨科患者指南033：腰椎前路融合术（上）

Anterior Lumbar Interbody Fusion

腰椎前路融合术

A Patient’s Guide to Anterior Lumbar Interbody Fusion

腰椎前路融合术患者指南

Introduction

引言

 

 

Anterior lumbar interbody fusion (ALIF) is a procedure used to treat problems such as disc degeneration, spine instability, and deformities in the curve of the spine. In this procedure, the surgeon works on the spine from the front (anterior) and removes a spinal disc in the lower (lumbar) spine. The surgeon inserts a bone graft into the space between the two vertebrae where the disc was removed (the interbody space). The goal of the procedure is to stimulate the vertebrae to grow together into one solid bone (known as fusion). Fusion creates a rigid and immovable column of bone in the problem section of the spine. This type of procedure is used to try and reduce back pain and other symptoms. 

        腰椎前路融合术用于治疗椎间盘退变，脊柱不稳，以及脊柱畸形。术中，术者通过脊柱前方入路，切除腰椎的间盘。同时在切除间盘的椎体间隙置入合适的骨移植物。手术的目的是使相邻上下两个椎体长在一起成为一个结实的整体（所谓椎体融合）。融合使有问题的脊柱节段变成一个坚硬的不可移动的骨柱。这一方法常常可减轻背痛和其他的不适。

This guide will help you understand

· what surgeons hope to achieve

· what happens during surgery

· what to expect as you recover

　　这一指南有助于你理解：

　　·外科医生通过手术想实现什么

　　·术中可能会有哪些情况发生

　　·患者康复时可能遇到什么样的问题

Anatomy

解剖

 
What parts of the spine and low back are involved?

　　涉及脊柱及腰部的哪些部分？

 

ALIF surgery is performed through the front (anterior). The structures in this area include the anterior longitudinal ligament, the vertebral bodies, and the intervertebral discs. The anterior longitudinal ligament attaches along the front of the spinal column. The vertebral bodies are the large blocks of bone that make up the front section of each vertebra.The intervertebral discs are the cushions between each pair of vertebrae.

　　ALIF手术从前方入路而进行。这一区域的结构包括前纵韧带、椎体和椎间盘。前纵韧带附着于脊柱前柱。椎体是指椎骨的前方大块骨。椎间盘是位于相邻椎体间的垫子。

 

Related Document: A Patient’s Guide to Lumbar Spine Anatomy

相关阅读：腰椎解剖患者指南（翻译招募中，有意者留言）

精美视频：腰椎解剖（lumbar 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? 

        外科医生希望通过手术达到什么目的？

This procedure is often used to stop symptoms from lumbar disc disease. Discs degenerate, or wear out, as a natural part of aging and also from stress and strain on the back. Over time, the disc begins to collapse, and the space decreases between the vertebrae. 

本手术用于消除腰椎间盘疾患的症状。 作为自然老化的一部分，以及腰部应力和扭伤等因素，引起椎间盘退变或磨损。 随时间的推移，间盘破裂，椎间隙高度降低。

Related Document: A Patient’s Guide to Lumbar Dengenerative Disc Disease

相关阅读:

         英汉对照骨科患者指南009：腰椎间盘退变性疾病（上）

        英汉对照骨科患者指南009：腰椎间盘退变性疾病（下）

相关视频：腰椎间盘退变性疾病（Lumbar Degenerative Disc Disease）

When this happens, the openings around the spinal nerves (the neural foramina) narrow and may put pressure on the nerves. The long ligaments in the spine slacken due to the collapse in vertebral height. These ligaments may buckle and put pressure on the spinal nerves.

       当椎间孔即神经出口狭窄时，会对神经造成挤压。同时由于椎体高度的丢失，附着于椎体的韧带会变得松弛，也会对脊神经产生挤压作用。

View animation of degeneration

观看椎间盘退变的动画

Also, the outer rings of the disc, the annulus, weaken and develop small cracks. Tears in the outer annulus are painful because these tissues are rich with pain sensors. The nucleus in the center of the disc may press on the weakened annulus and actually squeeze out of the annulus (herniate). Inflammation from the nucleus as it escapes the annulus also causes pain. The nucleus normally does not come in contact with the body’s blood supply. However, a tear in the annulus puts the nucleus at risk for contacting this blood supply. When the nucleus herniates into the torn annulus, the nucleus and blood supply meet, causing a reaction of the chemicals inside the nucleus. This produces inflammation and pain.

　　椎间盘的外缘即纤维环退变，出现小的裂口。因纤维环富有痛觉感受器，故当它撕裂时会出现疼痛。髓核位于间盘中央，它可挤压退变的纤维环，最终挤出纤维环而形成突出。突出的髓核可发生炎症反应引起疼痛。通常情况下，位于纤维环中央的髓核是无血供的，然而，纤维环的撕裂可能会使突出的髓核接触到血供。当突出的髓核和血供接触时会诱发髓核发生化学反应。这一过程将会引起炎症和疼痛。

 
If the nucleus presses against the spinal nerves, symptoms of pain, numbness, and weakness may occur where the nerve travels. Pressure on the spinal nerves inside the spinal canal can also produce problems with the bowels and bladder, requiring emergency surgery.

       当突出的髓核挤压邻近的神经时会出现疼痛、麻木及无力症状。椎管内的直接的脊髓神经受压可引起肠道和膀胱的问题，需要紧急手术。

Discectomy is the removal of the disc (and any fragments) between the vertebrae that are to be fused. Taking out the painful disc is intended to alleviate symptoms. It also provides room for placing the bone graft that will allow the two vertebrae to fuse together. The medical term for fusion is arthrodesis.

       椎间盘切除术是切除两融合椎之间的间盘和碎片。切除引起疼痛的间盘目的是减轻患者症状。同时突出间盘的去除将为植入两融合椎之间的骨移植物提供了空间。医学词汇的融合是指关节融合术。

Once the disc is removed, the surgeon spreads the bones of the spine apart slightly to make more room for the bone graft. The bone graft separates and holds the vertebrae apart. Enlarging the space between the vertebrae widens the opening of the neural foramina, taking pressure off the spinal nerves that pass through these openings. Also, the long ligaments that run up and down inside the spinal canal are pulled taut so they don’t buckle into the spinal canal.

       一旦间盘被移除，外科医生会适度撑开两椎体以获得更多的骨移植空间。骨移植物使椎体分开同时起到维持作用。增加椎间高度会使神经出口增大，从而减轻对神经的压力。同样，椎管内的长韧带因椎间隙的增加而变得紧张，不再松弛突入椎管。

View animation of spreading vertebrae apart

       看椎体撑开的动画

View animation of graft fusion

       看移植物融合的动画

 

If the fusion is successful, the vertebrae that are fused together no longer move against one another. Instead, they move together as one unit. This helps relieve the mechanical pain, which occurs in the moving parts of the back. Fusion also prevents additional wear and tear on the spinal segment that was fused. By fusing the bones together, surgeons hope to reduce future problems at the spinal segment.

       如果椎体融合成功，融合椎将不再单个运动。相反，它们成为一体而运动。这将减轻患者因椎体不稳而产生的机械性疼痛。融合同时还能预防同一脊柱节段的额外磨损。通过椎体的融合，外科医生希望减少这一脊柱融合节段的未来问题。

Preparations

术前准备

How will I prepare for surgery?

　　术前需要做什么准备工作？

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.

 　　手术进行与否需要由您及您的外科医生共同决定。你应该更多了解手术相关的步骤。如果您有忧虑和疑问，您应该及时和您的外科医生沟通。

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.

　　当您决定进行手术时，您的外科医生会建议您的日常医生为您做全面体检，以保证术前您具有良好的身体状况。

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.

　　手术当日，您需要早早的来到医院。从术前那天的午夜开始禁食、禁饮。

Surgical Procedure

手术步骤

What happens during the operation?

　　手术中会发生什么？

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.

　　大多数脊柱手术病人采用全身麻醉，整个手术过程病人处于睡眠状态。再此过程中，患者的呼吸由呼吸机辅助。呼吸机是一种能够控制和监测空气流动到肺的装置。

The patient is positioned on his or her back with a pad placed under the low back. An incision is made through one side of the abdomen. The large blood vessels that lie in front of the spine are gently moved aside. Retractors are used to gently separate and hold the soft tissues apart so the surgeon has room to work.

　　患者取平卧体位，腰下垫软垫。切口位于腹部一侧。脊柱前方的大血管被轻拉到一边。牵开器轻柔地分离并维持软组织的分开，以使外科医生有操作空间。

 
The surgeon inserts a needle into the disc. By taking an X-ray with the needle in place, the correct disc is identified. Forceps are used to open the front of the disc. Next, a tool is attached to the vertebrae to spread them apart. This makes it easier for the surgeon to see between the two vertebrae. A small cutting tool (a burr) is used to carefully remove the front half of the disc. A special surgical microscope may be used to help the surgeon see while removing pieces of disc material near the back of the disc space.

　　穿刺针插入间盘，和x-ray来确认节段正确。通常用钳子分开间盘的前方，然后使用一个工具固定于椎体上，并将它们撑开，这样利于外科医生看清椎体间隙。一小的切割工具（磨钻）小心切除间盘的前半部。在切除间盘后方结构时，使用一个特殊的手术显微镜可使外科医生的视野清晰。

The surgeon shaves a layer of bone off the flat surfaces of the two vertebrae. This causes the surfaces to bleed. Bleeding stimulates the bone graft to heal and join the bones together.

　　外科医生刮除椎体相邻椎骨表面的一层骨质（软骨终板），这会使骨表面出血。出血会刺激移植骨愈合并连接在一起。

 

 
The surgeon measures the depth and height between the two vertebrae. Making a separate incision, the surgeon takes a section of bone from the top of the pelvis to use as a graft. The graft is measured to fit snugly in the space where the disc was taken out. The surgeon uses a traction device to spread the two vertebrae apart, and the graft is tamped into place.

　　外科医生测量两个椎骨之间的深度和高度。另取一单独的皮肤切口，在骨盆高处取一髂骨充当骨移植物。移植物被修整成与椎间隙大小相匹配。外科医生使用撑开器使椎间分离，同时置入并夯实骨移植物。

Traction is released. Then the surgeon tests the graft by bending and turning the spine to make sure the graft is in the right spot and is locked in place. Another X-ray may be taken to double check the location and fit of the graft.

　　去除撑开器。然后外科医生通过弯曲和扭动脊柱来测试移植物，以确保移植物在正确的位置并且被牢固固定在合适的位置。X射线被作为二重检查来确保移植物的位置及合适状况。

 
Most surgeons apply some form of metal hardware, called instrumentation, to prevent movement between the vertebrae. Instrumentation protects the graft so it can heal better and faster. One option involves screwing a strap of metal across the front surface of the spine over the area where the graft rests. A second method involves additional surgery through the low back, either on the same day or during a later surgery. In this operation, metal plates and screws are applied through the back of the spine, locking the two vertebrae and preventing them from moving.

　　大多数外科医生会使用一种被称为内固定物的某种形状的金属硬件来防止椎骨之间的运动。内固定物可保护移植物使它可以愈合的更快更好。一种选择是在脊柱前方移植物上下缘椎体上、下用螺钉将条形金属板固定。第二种方法是行前路手术的同时在背部进行另外的手术，或者二期行背部手术。在后路手术中，金属板和螺钉通过脊柱的后部，固定两个椎体并阻止它们移动。

Related Document: A Patient’s Guide to Posterior Lumbar Fusion