英漢對照骨科患者指南002：人工頸椎間盤置換術（上）
人工頸椎間盤置換術
A Patient』s Guide to Cervical Artificial Disc Replacement
人工頸椎間盤置換術指南
Introduction簡介
相比較而言，人工頸椎間盤置換術是一項新技術。在2004年6月，美國FDA批准開展了第一例人工腰椎間盤置換術。而置換受損的頸椎間盤有點棘手。椎間盤是脊柱中複雜關節的一部分。想要讓置換的椎間盤能運作並能持久發揮作用，這並非易事。現如今有幾種人工頸椎間盤置換裝置已經在美國獲得FDA的批准。
動畫：人工腰椎間盤置換術
精美動畫：人工頸椎間盤置換術（附中英文解說）
The artificial disc is inserted in the space between two vertebrae. The goal is to replace the diseased or damaged disc while keeping your normal neck motion. The hope is that your spine will be protected from similar problems above and below the affected spinal level.
人工間盤植入於兩椎體間。其目的是置換病變或損傷的椎間盤並保持頸部正常的運動。希望保護你的脊柱免受相鄰病變椎節的影響而產生類似問題。
This guide will help you understand:
本指南將幫助您了解以下內容：
·what parts of the spine are involved
病變脊柱部位
·what your surgeon hopes to achieve
外科醫生預期療效
·who can benefit from this procedure
手術適用人群
·how do I prepare for surgery
手術準備
·what happens during the procedure
手術步驟
·what to expect as you recover
術後康復
Anatomy解剖What parts of the spine are involved?
涉及到哪個部位的脊柱？
通常椎間盤置換在頸4-5、5-6或6-7頸椎水平進行。頭端七個椎體構成了頸椎。醫生們經常所指的頸椎是指頸1到頸7。頸椎起始於頸1與顱底的連接處。頸椎曲度輕度前凸，終止於頸7在胸1連接胸椎處。
Each vertebra is made of the same parts. The main section of each cervical vertebrae, from C2 to C7,is formed by a round block of bone, called thevertebral body. A bony ring attaches to the back of the vertebral body. This ring has two parts. Twopediclesconnect directly to the back of the vertebral body. Twolamina bonesjoin the pedicles to complete the ring. The lamina bones form the outer rim of the bony ring. When the vertebrae are stacked on top of each other, the bony rings form a hollow tube that surrounds the spinal cord. The laminae provide a protective wall around the spinal cord.
每個椎體由類似的部分構成。從頸2到頸7，每個頸椎的主要部分是由被稱之為椎體的圓形骨塊構成。一個骨性環連接椎體背側。骨環有兩部分構成。兩個橫突直接連接椎體背側。兩側椎板連接橫突封閉骨環。椎板構成了骨環的外側邊緣。當脊椎相互堆疊，骨環則組成了一個圍繞脊髓的中空管道。橫突提供了圍繞脊髓的保護結構。
On the left and right side of each vertebra is a small tunnel called aneural foramen. (Foraminais the plural term.) The two nerves that leave the spine at each vertebra go through the foramina, one on the left and one on the right. The intervertebral disc sits directly in front of the opening. A bulged or herniated disc can narrow the opening and put pressure on the nerve. Afacet jointsits behind the foramen. Bone spurs that form on the facet joint can project into the tunnel, narrowing the hole and pinching the nerve.
一個稱之為神經孔的小孔道位於每個脊椎的左右兩側。每個脊椎中分出兩條神經通過神經孔一左一右離開脊柱。椎間盤直接位於神經孔開口前方。膨出或者突出的椎間盤能使開口變得狹窄繼而使神經受壓。關節突關節位於神經孔後方。形成於關節突關節的骨刺能突入孔道，狹窄孔道擠壓神經。
脊柱中一個特殊結構稱為椎間盤，它有兩部分。中心富有彈性的稱為髓核。它提供大部分的緩衝。髓核受纖維環局限，纖維環是圍繞髓核的堅韌的韌帶組織。
Related Document:A Patient』s Guide to Cervical Spine Anatomy
相關文獻：頸椎解剖指南
英漢對照：有關頸椎解剖的病人指南
精美動畫：頸椎解剖動畫演示
Rationale理論基礎What does the surgeon hope to achieve?
外科醫生希望達到什麼？
Disc replacement surgery is done to stop the symptoms ofdegenerative disc disease. Discs wear out ordegenerateas a natural part of aging and from stress and strain on the neck. Eventually, the problem disc collapses. This causes the vertebra above to sink toward the one below. This loss of disc height affects the nearby structures – especially the facet joints.
椎間盤置換手術目的在於阻斷退變性椎間盤疾病的癥狀。由於自然老化或者頸部壓力以及應力，椎間盤出現損傷或者退變。最終，病變椎間盤嚴重損壞。這使得上一個椎體靠近下一個椎體。椎間隙高度的丟失影響了周圍結構——尤其是關節突關節。
When the disc collapses, it no longer supports its share of the load in the cervical spine. The facet joints of the spine begin to support more of the force that is transmitted between each vertebra. This increases the wear and tear on thearticular cartilagethat covers the surface of the joints. The articular cartilage is the smooth, slippery surface that covers the surface of the bone in any joint in the body. Articular cartilage is tough, but it does not tolerate abnormal pressure well for long. When damaged, articular cartilage does not have the ability to heal. This wear and tear is what is commonly referred to asarthritis.
當椎間盤嚴重損壞，它不再分擔頸椎的負重。脊柱的關節突關節開始承受更多來自於脊椎間的壓力。這會增加關節突關節表面軟骨的磨損以及應力。關節軟骨是附著在身體任何關節骨表面光滑的淺層。關節軟骨雖然堅韌，但它不能長時間較好的承受非正常壓力。當受損，關節軟骨無自愈能力。這種關節面磨損以及應力，我們一般稱為關節炎。
Shrinking disc height also reduces the size of the neural foramina, the openings between each vertebral pair where the nerve roots leave the spinal column. The arthritis also results in the development of bone spurs that may protrude into these openings, further narrowing the space that the nerves have to exit the spinal canal. The nerve roots can end up getting squeezed where they pass through the neural foramina.
不斷壓縮的椎間盤高度也減少了椎間孔的尺寸，椎間孔是位於脊椎間的開口，神經根由此離開脊柱。關節炎導致骨刺的形成，這也會突入椎間孔，進一步狹窄神經離開脊髓腔的空間。神經根在通過椎間孔處受壓。
The traditional way of treating severeneck paincaused by disc degeneration is a procedure called ananterior cervical discectomy and fusion. In this procedure, the surgeon makes an incision in theanterior(front) of the neck, performs adiscectomy(removes the disc) andfusesthe two vertebrae together. A fusion simply means that two bones grow together. Usually, when two vertebrae are fused together, a small piece of bone called a bone graft is inserted between the two vertebrae where the disc has been removed. This bone graft serves to both separate the vertebrae and to stimulate the two bones to grow together – or fuse.
治療由椎間盤退變引起的嚴重頸部疼痛的傳統方法稱為頸前路椎間盤摘除融合術。手術中，外科醫生在頸前做一切口，行椎間盤切除，然後融合相鄰兩個脊椎。融合簡單意味著兩個骨塊生長在一起。通常當兩個脊椎融合，需要在兩個脊椎中去除椎間盤處植入一小塊移植骨。這移植骨充當分離脊椎以及促進脊椎生長在一起或者融合。
精美動畫：頸椎椎間融合VS人工頸椎間盤置換
精美動畫：頸前路椎間盤切除融合術
The fusion procedure usually involves the use of hardware, such as screws, plates, or cages to keep the bones from moving. Fusion restricts movement in the problem area, but it creates greater strain on the healthy spinal segments above and below. The added strain may eventually cause these segments to wear out. This is calledadjacent-segment degeneration.
為了保持椎骨移動，融合術通常需要使用金屬器械，例如螺釘，金屬板，金屬籠。融合術限制病變部位的移位，但它導致上下兩側的正常脊柱節段更嚴重的應力。增加的應力最終導致這些節段的磨損。這稱為相鄰節段退變。
Replacing the damaged disc with an artificial disc, or implant, called aprosthesiscan restore the normal distance between the two vertebrae. The artificial disc sits between the two vertebrae and 「jacks up」 the upper vertebra. Enlarging the disc space relieves pressure on the facet joints. It also opens up the space around the spinal nerve roots where they pass through the neural foramina.
用人工椎間盤或者假體替換受損的椎間盤恢復了脊椎間的正常距離。人工椎間盤位於兩脊椎間，並頂起上位脊椎。增大的椎間盤空間緩解了關節突關節的壓力。同時也擴大了脊神經根通過神經孔的空間。
Another benefit of the artificial disc replacement is that it mimics a healthy disc. Natural motion is preserved in the spine where the new disc is implanted. And it helps maintain stability in the spinal joints above and below it.
人工椎間盤置換術的另一優點是它模擬了正常椎間盤。所植入的人工椎間盤能維持脊柱正常運動。它有助於維持脊柱關節的穩定。
Who can benefit from this procedure哪些人適合做這個手術
The indications for a cervical disc replacement are generally the same as for acervical discectomyand fusion. A person must have symptoms from a cervical disc problem. Symptoms include neck and/or arm pain, arm weakness, or arm andhandnumbness. These symptoms may be due to a herniated disc and/or bone spurs calledosteophytespressing on adjacent nerves or the spinal cord. This condition typically occurs at cervical spine levels C4-5, C5-6, or C6-7.
一般說來，頸椎間盤置換術的適應症與頸椎間盤切除融合術相同。患者必須有頸椎間盤疾患的癥狀。這包括頸或者手臂疼痛，上肢無力，或者手臂以及手麻木。這些癥狀可能由於脫出的椎間盤或骨刺擠壓毗鄰的神經或者脊髓所致。這種情況一般發生在頸4-5、5-6或6-7水平。
Artificial disc replacement is still somewhat new in the United States. In the United States, surgeons are currently only replacing one cervical disc in a patient』s cervical spine at this time. In Europe, surgeons are replacing more than one disc. More surgeons in the United States will probably start replacing more than one cervical disc in the near future.
人工椎間盤置換術在美國仍是新技術。目前在美國，外科醫生僅能在一個病人的頸椎置換一個椎間盤。在歐洲，外科醫生能置換超過一個椎間盤。在美國更多的外科醫生將可能開始在不遠的將來置換不止一個椎間盤。
Cervical artificial disc replacement is indicated for the treatment ofradiculopathy(pressure on the spinal nerve) andmyelopathy(pressure on the spinal cord) at one or two levels. In the future, it may be used for the treatment of three or more symptomatic levels or levels adjacent to a cervical spine fusion. This use is still under investigation.
人工頸椎間盤置換術適用於一到兩個水平的神經根型頸椎病以及脊髓型頸椎病。在將來，它將被用於治療與頸椎融合術相似的三個或者更多病變水平。這種方法仍待檢驗。
More data is needed before the uses of cervical artificial disc replacements are expanded to other problems in the cervical spine. Cervical artificial disc replacement is not advised when there is cervical spine instability, significant facet joint damage, or infection.
在擴大應用人工頸椎間盤置換術到頸椎其他問題前，需要搜集更多數據。當有頸椎失穩，明顯的關節突關節損傷或者感染時，不建議行頸椎間盤置換術。
Preparation準備
How should I prepare for surgery?
我需要為手術做哪些準備呢？
Your spine surgeon will gather a variety of information before recommending disc replacement surgery. In addition to taking a history and doing a physical exam, your surgeon may order various diagnostic studies, such as x-rays, magnetic resonance imaging (MRI) scans, CT scans, or discograms.
你的脊柱外科醫生將在提議椎間盤置換術前搜集各類信息。除病史採集以及體格檢查外，外科醫生可能會安排各種診斷性檢查例如X線、核磁共振、CT或者造影術。
Once you and your surgeon have agreed that disc replacement surgery is indicated, certain preparations for the surgery are important. Your doctor may tell you to beNPOfor a certain amount of time before the procedure. This means that you should not eat or drink anything for a certain amount of time before your procedure. This means no water, no coffee, no tea – not anything. You may receive special instructions to take your usual medications with a small amount of water. Check with your doctor if you are unsure what to do.
一旦你和你的外科醫生都同意椎間盤置換手術，某些外科術前準備是很重要的。你的醫生可能會讓你在術前禁食一段時間。這意味著你在術前一段時候不能吃或喝任何東西。這表示不能喝水、喝咖啡、喝茶等等任何東西。你可能需要接受特殊醫囑，用少量水服用你平時的藥物。如果你不確定你要做什麼，詢問你的醫生。
You should tell your doctor if you are taking any medications that thin your blood or interfere with blood clotting. The most common blood thinner isCoumadin. Other medications also slow down blood clotting. Aspirin, ibuprofen, and nearly all of the anti-inflammatory medications affect blood clotting. So do medications used to prevent strokes such as Plavix. These medications usually need to be stopped seven days prior to the procedure. Be sure to let your doctor know if you are on any of these medications.
如果你正在服用任何藥物來稀釋血液或者影響血液凝固，你應當告訴你的醫生。最常見的血液稀釋藥物是香豆定。其他藥物也減慢血液凝固。阿司匹林，布洛芬以及近乎所有抗炎藥物都影響血液凝固。同樣的用於預防中風的藥物例如波力維。這些藥物通常需要術前停用7天。如果你在服用任何這些藥物，一定要告訴你的醫生。
You should stop smoking or usingtobaccoin any form as soon as possible before surgery. This is very important to reduce complications from heart and lung problems. Tobacco use, especially smoking, also decreases the success rate of spine surgery. Stopping smoking will increase your chances of a successful result.
術前你應當儘可能戒煙或者任何形式的煙草。這對於減少心肺併發症很重要。煙草使用尤其吸煙也會降低脊柱手術成功率。戒煙會增加你手術成功的幾率。
Discussions will be held with your family and people who may be assisting you once you return from the hospital. You may need to visit your primary care physician or internal medicine specialist to obtain medical clearance for surgery. This will ensure that you are in the best medical condition possible prior to the surgery.
一旦你出院，需要和你的家人以及你的護理人員進行商討。你需要向你的康復醫師或者內科專科醫師為手術獲得醫療許可。這能確保你在術前處於最佳醫學狀態。
Hospitals often have preoperative teaching for patients undergoing major spinal operations. These teaching sessions can help you understand what to expect both while you are in the hospital and after you return home. A doctor who will be performing your anesthesia (an anesthesiologist) will evaluate and counsel you regarding anesthesia.
醫院通常會對準備行脊柱大手術的病人開展術前宣教。這種教育活動能幫助你了解當你在院以及出院所需要做的事情。你的麻醉師的醫生會評估以及諮詢你相關的 麻醉事項。
Surgical Procedure手術步驟
What happens during the operation?
手術如何進行呢?
Before we describe the procedure, let』s look first at the artificial disc itself.
在講述手術前，讓我們首先看看人工椎間盤。
The cervical artificial disc has several different designs. Some look like a sandwich with two endplates separated by a plastic spacer. The two endplates are made of cobalt chromium alloy, a safe material that has been used for many years in replacement joints for thehipandknee.
人工頸椎間盤有幾種不同的設計。一些看起來像三明治，它有兩個有塑料墊分隔的終板。這兩個終板有鈷鉻合金製成，這是一種多年來被用於髖以及膝關節置換的安全材料。
A plastic (polyethylene) core fits in between the two metal endplates. The core acts as a spacer and is shaped so that the endplates pivot in a way that imitates normal motion of the two vertebrae. There are small prongs on one side of each endplate. The prongs help anchor the endplate to the surface of the vertebral body.
一種塑料核心填入兩個金屬終板中。這個核心充當間隔器，其形狀利於終板迴轉滾軸，從而模仿兩脊椎的正常運動。在每個終板的一側有小的叉子，這些叉子能將終板固定在椎體表面。
Another artificial disc replacement design is a ball and socket articulation to allow for normal translation of motion at that segment. The implant may be made of titanium and polyurethane in a metal-on-plastic design. Some are made of stainless steel and are all metal-on-metal.
另一種人工椎間盤設計是一個球和臼連接，利於節段正常的運動。植入物可能由鈦和聚氨酯以一種金屬-塑料結構設計。一些是由不鏽鋼構成臼,構成全金屬-金屬連接。
Inserted between two vertebrae, the prosthesis reestablishes the height between two vertebrae. As a result of enlarging the disc space, the nearby spinal ligaments are pulled tight, which helps hold the prosthesis in place. The prosthesis is further held in place by the normal pressure through the spine.
植入兩脊椎之間的假體能重塑脊椎間的高度。擴大的椎間隙可以使得脊柱周圍的韌帶被拉緊，這有助於固定假體在位。脊柱間正常的壓力進一步將假體固定在位。
The Operation手術
The operation is done from theanterior(front) of the body. This surgical approach is the same as that presently used for a discectomy and fusion operation. To do this, the patient is placed on his or her back. An incision is made through the skin and the thin muscles of the front of the neck. The blood vessels, thetrachea(windpipe), and the esophagus are moved to the side so that the surgeon can see the front of the cervical spine. The disc that is to be replaced is identified using thefluoroscope. The fluoroscope is an x-ray machine that allows the doctor to actually see an x-ray image while doing the procedure.
手術應用前路入路。這種外科方法與目前椎間盤切除以及融合術相同。為了這麼做，患者取仰卧位。切口經皮膚以及頸闊肌。將血管、氣管以及食管移到一側，這樣能使手術醫生看到頸椎前緣。使用透視明確需要置換的椎間盤。透視是應用一種X線機，它能使醫生在手術時看到X線片。
Working from the front of the spine, the spine surgeon removes a large section from the middle of the damaged disc. Next, the bones of the spine are spread apart to make more room to see and work inside the disc space. Using a surgical microscope, any remaining disc material toward the back of the disc is removed. The surgeon will also remove any disc fragments pressing against the nerve and shave off anyosteophytes(bone spurs).
從脊椎前路手術，脊柱外科醫生移除病變椎間盤中央大部分。然後，清除椎體前緣多餘的骨贅以擴大椎間隙手術操作視野以及操作區域。用外科顯微鏡來清除背側殘留的椎間盤組織。外科醫生會切除壓迫神經的椎間盤碎片，或者切除骨贅（骨刺）。
The disc space isdistracted(jacked up) to its normal disc height. This step helps decompress or take pressure off the nerves. At this point, x-rays or a fluoroscope, is used to insert the artificial disc device into the prepared disc space. This allows the doctor to watch where the implant goes as it is inserted. This makes the procedure much safer and much more accurate.
撐開椎間隙到正常高度。這一步有助於減壓或者去除神經壓迫。此時，X線或者透視用於植入人工椎間盤到減壓好的椎間隙。這讓醫生能觀察植入物的位置。這也讓手術更安全更準確。
Finally, the prosthesis is tested by moving the spine in various positions. An X-ray may be taken to double check the location and fit of the new disc.
最後，通過按不同方位移動脊柱來測試假體。使用X線正側位檢查新椎間盤的位置以及匹配。
View animation of artificial disc replacement
觀看人工椎間盤置換術動畫精美動畫：人工頸椎間盤置換術（附中英文解說）翻譯：郭曉峰（南通大學2016屆骨科研究生）
校對：保國鋒
保國鋒，南通市第一人民醫院脊柱外科，副主任醫師，碩士生導師、醫學博士。江蘇省「333高層次人才」培育對象、南通市醫學重點人才、南通市「226高層次人才」培養對象。社會兼職：江蘇省醫學會骨科分會創傷學組委員、江蘇省中西醫結合學會骨科分會委員、北美脊柱外科學會(NASS)會員、南通市中西醫結合學會骨科分會委員。擅長頸肩腰腿痛、脊柱脊髓損傷、腦癱等手術治療。2011年、2014年、2016年曾在澳大利亞Latrobe大學、德國OberlinHaus醫院、德國科隆大學醫院和韓國首爾國立大學醫院（SNUH）研修脊柱外科。
門診時間：周五全天
患者指南，圖文並茂，
分門別類，構思巧妙。
深入淺出，中英對照，
醫患攜手，共同探討。
能力有限，時間倉促，
錯誤難免，誠惶誠恐。
懇請各位，留言指導，
以利再版，更加周到。
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