英汉对照骨科患者指南008：椎体成形术

Vertebroplasty

椎体成形术

A Patient’s Guide to Vertebroplasty

椎体成形术患者指南

Introduction

简介

Patients with  are prone to  in the spine bones, or vertebrae. The front of a vertebra cracks under pressure, causing it to collapse in height. More than 700,000 such fractures occur every year in the United States. These fractures often cause poor back posture, debilitating pain, and difficulty completing routine activities.

骨质疏松症患者很容易发生背脊骨（脊椎骨）的压缩骨折，即椎体前部受压碎裂，导致其高度的塌陷。在美国，每年有超过700000人发生这类骨折。这些骨折常常引起背部姿势不良、使人衰弱的疼痛，并难以完成日常的活动。

Vertebroplasty restores the strength of the fractured bone, thereby reducing pain. More than 80 percent of patients get immediate relief of pain with this procedure.

椎体成形术使发生骨折的骨头的恢复强度，从而减少疼痛。这个手术后有80%以上的病人疼痛症状立即获得缓解。

This guide will help you understand

· why the procedure becomes necessary

· what surgeons hope to achieve with vertebroplasty

· what to expect during recovery

本指南将帮助您了解

•为什么这个手术是必要的？

•外科医生希望通过椎体成形术达到什么样的效果？

•恢复期间预期会发生什么？

Anatomy

解剖

What parts of the spine are involved?

涉及到脊柱的哪一段？

The main section of each spine vertebra is a large, round block of bone called a vertebral body. Compression fractures cause this section of bone to collapse.

   每个脊椎骨的主要部分是一个又大又圆的骨块称为椎体。压缩性骨折引起这部分骨的崩塌。

The collapsed vertebra gives the spine a hunched appearance, called , and the loss of vertebral height shortens the muscles on each side of the spine.

   塌陷的脊椎骨使脊柱看起来向后隆起，称为后凸畸形。椎体高度的损失使脊柱两侧肌肉缩短。

This forces the back muscles to work harder, causing muscle fatigue and pain. The vertebral body is the main structure treated in the vertebroplasty procedure.

这使得背部肌肉用力更费劲，引起肌肉疲劳和疼痛。椎体是椎体成形术中治疗的主要结构。

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Rationale

基本原理

What do surgeons hope to achieve?

外科医生希望获得什么效果？

In the past, surgeons used standard open surgery to fix compression fractures from osteoporosis. Open surgery requires larger incisions to give the surgeon more room to operate. The results of open surgery for this condition have generally been poor, mainly because it is difficult to do surgery on bones that are weak and soft from osteoporosis. In addition, some aging adults with fractures may not be physically able to tolerate such surgery.

以往，外科医生对骨质疏松性压缩性骨折采取标准的切开复位内固定术。开放手术需要很大的切口，给外科医生足够的空间操作。这种情况下做开放手术的疗效常常很差，主要是因为骨质疏松症病人的骨头又松又脆，在这样的骨头上做外科手术很困难。而且，有些年老的骨折病人身体上难以承受这样的手术。

Vertebroplasty gives surgeons a way to fix the broken bone without the problems associated with open surgery. Unlike open surgery, vertebroplasty is a minimally invasive procedure. It requires small openings in the skin and small instruments. This lessens the chance of bleeding, infection, and injury to muscles and tissues.

椎体成形术让外科医生有办法固定骨折的椎体，而不会出现与开放手术相关的问题。与开放手术不同，椎体成形术是一处微创的手术，仅需要小的皮肤切口和很小的仪器。这使出血、感染、肌肉和软组织损伤的机会大大减少。

Surgeons fix the bone in place by squeezing special cement into the broken bone. The cement strengthens and stiffens the vertebra, which reduces pain considerably and helps the patient return to normal activities.

外科医生通过向碎裂的骨内挤入特殊的水泥来将骨头修复起来。骨水泥使椎体加固变硬，从而减轻了疼痛，有助于病人恢复正常的活动。

This procedure doesn’t restore the original height of the broken vertebra, however. Nor does it prevent the kyphosis (hunchback) deformity that sometimes results from compression fractures.

这个手术不能恢复骨折椎体的正常高度，而且也不能防止有时因压缩性骨折引起的后凸畸形（驼背）。

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Preparations

术前准备

How will I prepare for the procedure?

我该如何为手术作准备？

The decision to proceed with vertebroplasty 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, talk to your surgeon.

   实施椎体成形术的决定必要由你和你的医生共同来作出。你必须尽可能了解这个手术。如有你有顾虑或问题，跟你的医生沟通。

Vertebroplasty is normally done on an outpatient basis, meaning patients go home the same day as the surgery. You shouldn’t eat or drink anything after midnight the night before.

   椎体成形术往往在门诊部做，这意味着病人做手术同一天可以回家。前一天午夜以后，你不能再吃或再喝任何东西。

Surgical Procedure

手术步骤

What happens during the procedure?

手术时会发生什么？

The patient lies on his or her stomach. To begin, the surgeon cleans the skin on the back with an antiseptic. Then the skin and muscles over the problem area are numbed using an anesthetic. Patients may also receive general anesthesia to put them to  during the procedure.

病人俯卧，开始时，医生会用消毒剂清洁皮肤，然后病变部位的皮肤和肌肉用麻醉药使之麻木。病人也可能接受全身麻醉，使其在手术中可以睡着。

A small incision is made in the skin on each side of the spinal column. A long needle is inserted through each opening. The surgeon slides the needles through the back of the spinal column into the fractured vertebral body.

脊柱两侧的皮肤各作一小切口，一根长针通过切口插进去，医生通过脊柱的背部将针插入骨折的椎体。

A fluoroscope is used to guide the needles. This is a special X-ray television camera adjusted above the patient’s back that lets the surgeon see the patient’s spine on a screen. Metal objects show up clearly on X-rays. The needles are easy for the surgeon to see on the fluoroscope screen. This helps the surgeon confirm that the needles reach the correct spot.

术中需要透视来引导针的插入，这是一个特殊的X线电视摄像头，在病人的背上调节，以便医生通过屏幕来观察病人的脊柱。金属物品在X线下能清晰地显示。医生在透视屏幕上很容易看到针。这帮助医生确定针到了合适的位置。

Once the needle is in place, special  bone cement, called polymethyl methacrylate (PMMA), is injected through the needle into the fractured vertebra.

针一旦插入到合适的合适，特殊的水泥，即聚甲基丙烯酸甲酯（polymethylmetharylate, PMMA），通过针穿入骨折的椎体。

A chemical reaction in the cement causes it to harden in about 15 minutes. This fixes the bone so it can heal. Bandages are placed over the small openings where the needles were inserted.

   骨水泥的化学反应使它在15分钟左右变硬。这样就把骨固定住，让它能够愈合。穿针的小口用创可贴覆盖包扎。

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Complications

并发症

What might go wrong?

哪些地方可能出错？

Serious complications from vertebroplasty are rare, involving less than five percent of cases. As with other procedures, however, complications can occur. Some of the most common complications of vertebroplasty include

   椎体成形术严重的并发症很罕见，只涉及不到5%的病例。与其他手术一样，并发症还是可能发生的。最常见的几个并发症包括：

· problems with anesthesia

· thrombophlebitis

· infection

· cement leakage

· ongoing pain

• 麻醉方面的问题

• 感染

• 骨水泥渗漏

• 疼痛未缓解

This is not intended to be a complete list of possible complications.

这里不打算把可能发生的并发症完整地列出来。

Problems with Anesthesia

麻醉意外

Problems can arise when the anesthesia given during surgery causes a reaction with other drugs the patient is taking. In rare cases, a patient may have problems with the anesthesia itself. In addition, anesthesia can affect lung function because the lungs don’t expand as well while a person is under anesthesia. Be sure to discuss the risks and your concerns with your anesthesiologist.

术中给的麻醉药可能与患者正在服用的其他药物之间有反应，就可能引起意外。在罕见病例，病人可能对麻醉药本身有反应。另外，麻醉药会影响肺功能，因为病人在麻醉状态，肺部扩张不良。千万记得要与你的麻醉师讨论风险和你所担心的问题。

Thrombophlebitis (Blood Clots)

血栓性静脉炎（凝血块）

Thrombophlebitis, sometimes called deep venous thrombosis (DVT), can occur after any operation. It occurs when the blood in the large veins of the leg forms blood clots. This may cause the leg to swell and become warm to the touch and painful. If the blood clots in the veins break apart, they can travel to the lung, where they lodge in the capillaries and cut off the blood supply to a portion of the lung. This is called a pulmonary embolism. (Pulmonary means lung, and embolism refers to a fragment of something traveling through the vascular system.) Most surgeons take preventing DVT very seriously. There are many ways to reduce the risk of DVT, but probably the most effective is getting you moving as soon as possible. Two other commonly used preventative measures include

      血栓性静脉炎，有时被称为深静脉血栓，在任何一个手术之后都可能发生。当腿部的大静脉中血液形成凝血块时发生。它会导致腿部的肿胀，皮温升高和疼痛。如果凝血块从静脉中脱落，它可以转移到肺部，阻塞肺部的毛细血管，阻断一部分肺的血供。这被称为肺栓塞。绝大多数的外科医生都非常认真地预防下肢深静脉血栓。有很多的方法可降低发生下肢深静脉血栓的风险，但是最有效的方法是让你尽快的下床活动。另外两种常用的预防措施包括：

· pressure stockings to keep the blood in the legs moving

· medications that thin the blood and prevent blood clots from forming

• 使用压力袜来保证下肢血液的流动

• 使用药物来稀释血液防止血栓的形成

Infection

感染

Infection following spine procedures is rare but can be a very serious complication. Some infections may show up early, within the first few days after the procedure. Infections on the skin’s surface usually go away with antibiotics. Deeper infections that spread into the bones and soft tissues of the spine are harder to treat. They may require surgery to treat the infected portion of the spine.

脊柱手术后感染较罕见，但却是一个非常严重的并发症。有些感染在手术后几天很早就显示出来。皮肤表面的感染通常用抗生素就能好转。扩散到脊柱和软组织的深部感染难以治疗。可能需要手术来处理脊柱感觉部位。

Cement Leakage

骨水泥渗漏

The cement used in vertebroplasty is in a liquid form and is squeezed into the fractured vertebra under high pressure. Some of the cement commonly leaks out of the vertebra, but this usually doesn’t cause any problems. Only rarely does a cement leak cause pressure on the spinal cord or nearby nerves. In these cases, surgery may be required to remove the pressure.

椎体成形术中使用的骨水泥是在液态时用高压注入骨折椎体里去的。一部分骨水泥常常漏出到椎体外面。这通常不会引起问题。只有很少的时候当骨水泥渗漏引起脊髓或周围神经受压时会引起症状。这时候，可能需要外科手术将压迫解除。

Ongoing Pain

持续疼痛

Many patients get nearly complete relief of symptoms from vertebroplasty. As with any procedure, however, you should expect some pain afterward. If the pain continues or becomes unbearable, talk to your doctor about treatments that can help control your pain.

   大多数病人通过椎体成形术疼痛几乎完全缓解。然而，象其他手术一样，术后多少会有些疼痛。如果疼痛持续存在并且难以忍受，问问医生有什么治疗可能帮助控制疼痛。

After Surgery

术后

What happens after surgery?

术后可能发生什么？

Patients are monitored in the recovery room for two to three hours after the procedure before going home. Patients are instructed to move their backs only carefully and comfortably. Some patients who feel extra pain or other problems after the procedure may need to stay in the hospital overnight.

   术后病人回前家将在恢复室观察2－3小时。医生会指示病人小心并舒适地活动腰部。有些病人术后感觉特别痛或有其他不适，可能需要住院过夜。

Patients rarely need to wear a brace after vertebroplasty, since bone cement immediately improves the strength and stiffness of the fractured vertebra.

椎体成形术后病人几乎不需要佩带支具，因为骨水泥很快就使骨折的椎体强化变硬。

Rehabilitation

恢复期

What should I expect as I recover?

在我恢复期需要做什么？

People often report greater ease with daily activities within a week after vertebroplasty. Pain also decreases rapidly, and most people require less pain medication within two weeks. Despite these quick improvements, most orthopedists consider that it takes about three months for the bone to heal after vertebroplasty.

人们通常报告在椎体成形术后1周日常活动就十分容易了。大部分病人在2周内很少需要止痛药。尽管改善很快，许多骨科医生认为椎体成形术后需要3个月骨头才能愈合。

Patients are encouraged to walk and do moderate activity as they recover. However, patients should avoid strenuous activity until the surgeon approves it.

恢复期间，病人被鼓励行走和中等程度的活动。但是，病人应该避免剧烈活动，除非等到医生同意。

When the fracture is from osteoporosis, the surgeon will suggest ways to prevent future problems. Patients may be prescribed medications and supplements (calcium and vitamin D) to maximize bone health. Lifestyle changes, such as quitting smoking and taking up exercising, may also be discussed.

如果是骨质疏松症引起的骨折，医生会建议如何预防骨折。医生可能会开药或者营养补充剂（钙和维生素D）以提高骨骼强度。生活方式的改变，比如戒烟，也会被提及。

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相关阅读：骨质疏松症患者指南（待翻译，有兴趣者请留言）

Patients who continue to have pain or who have lost muscle tone and strength may need the help of a physical therapist. These patients typically attend therapy sessions for four to six weeks.

如果病人持续疼痛或有肌张力或肌力的下降，可能需要物理治疗师的帮助。这些病人通常需要参加4－6周疗程的治疗。

The goal of therapy is to safely advance strength and function. The therapist may use treatments such as heat or ice, , or massage to calm pain. Gentle exercise improves the strength of the spine and limbs. Patients learn how to move safely using healthy postures to reduce strain on the healing back. Exercises for the heart and lungs improve stamina and help with pain control.

治疗的目标是安全地增强力量和功能。治疗师可能会使用类似热疗、冰敷、电刺激或按摩等治疗方法来缓解疼痛。轻柔的锻炼能提高脊椎和四肢的力量。病人学习如何以健康的姿势安全地移动来降低正在愈合的背部的负担。用于心肺锻炼的锻炼能增强持久力并有助于控制疼痛。

As the therapy sessions come to an end, the therapist helps patients get back to the activities they enjoy. Ideally, patients are able to resume normal activities. They may be counseled on which activities are safe or how to change the way they go about their activities.

当疗程结束，治疗师帮助病人回去他们喜爱的运动中去。理想的状况是病人能够恢复正常的活动。他们应该就何种运动是安全的或如何改变他们在活动中的方式寻求建议。

When treatment is well under way, regular visits to the therapist’s office end. The therapist continues to be a resource. But patients are in charge of doing their exercises as part of an ongoing home program.

   当治疗进行得很好时，定期访问治疗师的办公室。治疗师总是能给你方法。但是最终要靠病人负责将做那些练习作为的持续的家庭锻炼计划的一部分。

（胡佰文    译）

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