英汉对照骨科患者指南041：低头综合征

Dropped Head Syndrome

低头综合征

A Patient’s Guide to Dropped Head Syndrome

低头综合征患者指南

Introduction 

简介

Dropped Head Syndrome is characterized by severe weakness of the muscles of the back of the neck. This causes the chin to rest on the chest in standing or sitting. Floppy Head Syndrome and Head Ptosis are other names used to describe the syndrome.

　　低头综合征以患者在站立位或坐位时颈项部肌肉严重无力为特征，这会导致患者下巴倚靠在胸部。其它用来描述此类综合征的名称有头颅下垂综合征和垂头。

Most of the time, Dropped Head Syndrome is caused by a specific generalized neuromuscular diagnosis. When the cause is not known, it is called isolated neck extensor myopathy, or INEM.

　　大多数时候，头颅下垂综合征是由特定的一类神经肌肉病变引起。当原因不明时，称为孤立性颈伸肌肌病，简称INEM。                 

This guide will help you understand

　　这篇指南会帮助你了解：

· what parts make up the 

· what causes this condition

· how doctors diagnose this condition

· what treatment options are available

• 颈椎的组成

• 为什么会发病

• 医生如何诊断

• 治疗的选择

Anatomy 

解剖

What parts make up the cervical spine?

　　颈椎的组成

The spine is made up 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 for the spinal cord. The spinal cord is a made up of nerve cells which grow to look like a rope or cord about one half inch in diameter. The spinal cord attaches to the base of the brain. The base of the brain is called the brainstem.

　　脊柱是由排列成柱状的骨头组成。每一个骨头，或称为椎骨，是由一个圆形块状的骨头组成，称为椎体。在椎体的背部连有骨性圆环，它们连起来形成脊椎的通道。脊髓由神经细胞组成，看起来像直径约半英寸的绳索。脊髓连接到大脑的基底部。大脑的基底部称为脑干。

The vertebral column is divided into three distinct portions. The cervical, or neck portion attaches to the base of the skull at the upper end. The lower end of the cervical portion connects with the . There are seven cervical vertebrae.

　　脊柱被分成3个不同的部分。颈椎上面与大脑基底部相连接，在下面与胸椎相连。一共有7个颈椎椎体。

There are many muscles that lie in the neck region. Some attach from the base of the skull, others to the spine, ribs, collar bone,and  blade. Extension of the neck happens when the top of the head tilts backward. This causes the face and eyes to look up. Flexion of the neck is when the top of the head tilts forward. This causes the eyes to look down. It also lowers the chin to the chest.

　　颈部的区域分布了许多的肌肉。一些附着在颅骨的基底部，一些附着在脊柱，肋骨，锁骨和肩胛骨。当头顶部向后倾斜时发生了颈部的伸展。这会使得面部和眼睛向上看。头顶部向前倾斜时颈部就会屈曲。这会使得眼睛向下看，同时会使得下巴靠近胸部。

The vertebrae stack on top of one another. When looking at the spine from the side, or from the sagittal view, the vertebral column is not straight up and down, but forms an “S” curve. The cervical spine has an inward curve called a lordosis. The thoracic spine curves outward. This curve is called a . The  usually has an inward curve or a lordosis. The “S” curve seen in the sagittal or side view allows for shock-absorption and acts as a spring when the spine is loaded with weight.

　　椎骨间相互堆叠。当从侧面观察颈椎，或在矢状面观时，脊柱不是笔直的从上到下，而是形成了一个"S"型的曲线。颈椎有一个向内的弯曲称为脊柱前凸。胸椎向外弯曲，称为脊柱后凸。腰椎通常向内弯曲，为脊柱前凸。矢状面上的"S"型曲线可以减震并在脊柱承重时扮演弹簧的功能。

Related Document: 

相关阅读：英汉对照骨科患者指南015：颈椎解剖

Causes 

病因

What causes this condition?

　　引起这种情况的原因有哪些？

Most of the time, Dropped Head Syndrome is caused by a specific generalized neuromuscular diagnosis. These include amyotrophic lateral sclerosis (ALS) also known as Lou Gehrig’s disease, Parkinson’s disease, myasthenia gravis, polymyositis, and genetic myopathies. Other specific causes can include motor neuron disease, hypothyroidism, disorders of the spine, and cancer.

　　低头综合征多由特定的全身性的神经肌肉疾病引起的，包括肌萎缩性侧索硬化（ALS）（即为人熟知的Lou Gehrig病），帕金森病，重症肌无力，多发性肌炎和遗传性肌病。其他具体的病因包括运动神经元疾病，甲状腺功能减退，脊柱疾病和肿瘤。

When the cause of Dropped Head Syndrome is not known, it is called isolated neck extensor myopathy, or INEM.

　　当低头综合征的病因不明确时候，就被称为孤立性颈伸肌肌病，简称INEM。

The INEM form of Dropped Head Syndrome usually happens in older persons. The weakness of the muscles in the back of the neck usually occurs gradually over one week to three months.

　　孤立性颈伸肌肌病导致的低头综合征通常发生在老年人身上。颈后部肌肉的无力通常在一周至三个月内逐渐发生。

Symptoms 

症状

What does the condition feel like?

　　这种病有什么表现？

The symptoms of dropped head syndrome are usually painless. It most often occurs in the elderly. The weakness is limited to the muscles that extend the neck. Dropped Head Syndrome usually develops over a period of one week to three months. The head is then tilted downward. Because of the weakness of the extensors of the neck, the chin rests on the chest. Lifting or raising the head in sitting or standing is impossible. When lying down however, the neck is able to extend.

　　低头综合征的症状通常没有疼痛。它一般发生在老年人。肌肉无力通常只局限于伸展颈部的肌肉。低头综合征通常有一周至三个月的发展时间。然后头部向下倾斜。由于颈部伸肌的无力，下巴会紧靠胸部。在站立或坐着时候不能抬头。然而当躺下时，颈部可以伸展。

Gaze is down at the floor, instead of forward. The face is downward. The neck appears elongated, and the curve at the base of the neck is accentuated. This can cause over stretching or pinching of the spinal cord. When this happens, there may be weakness and numbness of the arms or entire body.

　　眼睛只能看着地板而不能看到前方，脸朝下。颈部看起来伸长，颈椎底部的曲线显得向后凸起。这可能导致脊髓的过度拉伸或挤压。当它发生时，可能会存在手臂或整个身体的无力和麻木。

Dropped head syndrome can also cause difficulty swallowing, speaking, and breathing.

　　低头综合征也会导致吞咽，说话和呼吸的困难。

Diagnosis

诊断

How will my doctor diagnose this condition?

医生会如何来诊断这种病？

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.

　　诊断首先需要完整的病史和体格检查。你的医生会询问你的症状以及你的病情对你的日常活动的影响。

Your doctor will do a physical examination to test your reflexes, skin sensation, muscle strength.

　　医生会做身体检查来测试你的反射、皮肤感觉和肌肉力量。

Most of the time, loss of of neck extension occurs as part of a more generalized neurological disorder. Neurological conditions must be considered first because some are treatable. A neurologist will usually be involved to help decide what is causing the chin-on-chest deformity.

　　颈部伸展功能的丧失往往作为全身性的神经疾病的一部分。必须首先考虑到神经系统疾病，因为其中一些是可治疗的。通常需要神经病学家参与进来帮助确定是什么造成了下巴紧贴胸部这种畸形。

Your doctor will likely ask that you have magnetic resonance imaging (MRI) of your neck. The MRI machine uses magnetic waves rather than X-rays. It shows the anatomy of the neck. It is very good at showing the spinal cord and nerves. The test does not require a dye or a needle.

　　医生可能会让你去做一个颈部的核磁共振检查。核磁共振检查是用的电磁波而不是X光。它会显示颈部的解剖，能很好地显示脊髓和神经，而且不需要穿刺和造影。

Electromygraphy (EMG) uses small diameter needles in the muscle belly being tested. It helps determine how well the nerve conducts signals to the muscles.

　　肌电图使用细针扎在肌腹处进行测试。它有助于确定神经信号传导到肌肉是否良好。

A muscle biopsy may be needed. A small piece of muscle is removed and examined under a microscope. A closer look at the muscle fibers can be helpful in making a diagnosis.

　　肌肉活检可能也会需要。取出一小块的肌肉并在显微镜下检查。仔细观察肌肉纤维有助于作出诊断。

In isolated neck extensor myopathy (INEM), the muscle biopsy is non-specific. EMG shows some myopathic changes. Labs are normal.

　　在孤立性颈伸肌肌病中，肌肉活检没有特异性。肌电图显示一些肌病改变。实验室检查是正常的。

If no other associated neurologic disorders are found, then the diagnosis of isolated neck extensor myopathy (INEM) is made. It is a diagnosis of exclusion, meaning that everything else that could caused it has been ruled out. It is not known what causes isolated neck extensor myopathy (INEM).

　　如果没有发现其他相关的神经系统疾病，那么可以作出孤立性颈伸肌肌病的诊断。这是排除的诊断方法，意思是其他所有可能导致这种情况的疾病都被排除了。孤立性颈伸肌肌病的病因尚未明确。

Some doctors feel that isolated neck extensor myopathy (INEM) is caused by either a non-specific non-inflammatory or inflammatory response that is restricted to the neck extensor muscles. Another possible cause is thoracic kyphosis. When the natural curve of the thoracic spine is increased, it may place the extensor muscles at a disadvantage given the weight of the head. This may cause over stretching and weakness of the extensor muscles.

　　有些医生认为孤立性颈伸肌肌病是由局限于颈伸肌的非特异性的非炎症或炎症反应造成的。另一个可能的原因是胸椎后凸。当胸椎的自然弯曲增大时，头部的重力会对颈伸肌带来不利影响，可能导致伸肌的过度拉伸和无力。

Treatment 

治疗

What treatment options are available?

　　有哪些治疗措施？

Isolated neck extensor myopathy (INEM) is considered benign because it does not spread or get worse. Symptoms can improve in some cases. It is most often treated conservatively.

　　孤立性颈伸肌肌病被认为是良性的，因为它不会扩散和变糟糕。在某些情况下症状可以改善。它通常被保守治疗。

Nonsurgical Treatment

保守治疗

Treatment of Dropped Head Syndrome is mainly supportive. The weakness remains localized to the neck extensor muscles, physical therapy may help with this. There are some cases that improve dramatically, but most usually do not improve.

　　低头综合征的治疗通常是支持治疗。无力局限于颈部的伸肌，物理治疗可能有效。有些情况下症状会戏剧性改善，但大多数情况下没有改善。

The most useful treatment is use of a neck collar. It can partially correct the chin-on-chest deformity. This improves the forward gaze and activities of daily living. It also can help prevent contractures of the neck in a fixed flexed posture. However, it can be uncomfortable and cause sores under the chin. Some use a baseball cap attached to straps around the trunk. This avoids the chin discomfort from using a collar.

　　最有用的治疗是使用颈托。它可以部分地纠正下巴紧贴胸部的畸形，使病人可以往前看，并改善日常活动。它还可以帮助防止颈部的固定弯曲姿势导致的挛缩。然而，它是不舒适的而且会导致下巴的压疮。有些病人使用连有带子绑在躯干上的棒球帽。它可以避免使用颈托引起的下巴不适。

Prednisone is a potent anti-inflammatory that may be prescribed. It may be beneficial when there is local myositis, or inflammation of the muscles. It can be taken in a pill form by mouth or intravenously.

　　泼尼松是一种强效的抗炎药，可能被开具处方。当存在局部肌炎时或肌肉有炎症时候，它可能是有益的。它可以以药片的形式口服或者静脉注射使用。

Surgery

手术

Unless fusion is necessary, surgery is usually not recommended in Dropped Head Syndrome.

　　除非需要融合，低头综合征一般不推荐手术。

When there is damage to the nerves in the neck or spinal cord, surgery to fuse the neck may be necessary. This usually requires a fusion from C2-T2. The loss of neck movement after fusion leaves patients unable to see the ground in front of their feet. This makes them at greater risk for falls. The inconvenience caused by having a rigid neck may prove to be a greater problem than the original dropped head deformity.

　　当颈部或脊髓中的神经受损时，可能需要进行手术以融合颈部。这通常需要作颈2至胸2的融合。融合后颈部运动的丧失使得患者看不到脚前方的地面。这增加了他们跌倒的风险。僵硬的颈部带来的不便可能比原本头颅下垂带来的问题更大。

, particularly in older females also poses a problem with surgery. The soft bone may allow the metal used to stabilize the spine to pull out.

　　骨质疏松症（特别是一些老年女性患者）是选择手术时可能面临的问题。松软的骨骼可能导致用来稳定脊柱的金属松动脱出。

Rehabilitation

康复

What should I expect as I after treatment?

　　治疗结束后还需要做此什么？

Nonsurgical Rehabilitation

保守治疗的康复

Physical therapy is usually recommended. Neck extension strengthening exercises may provide some improvement. However, most patients will find the strengthening both tiring and frustrating. When lying down on your back you can move the neck to maintain range of motion. This helps to avoid unnecessary stiffness and shortening of the muscles in the front of the neck.

　　通常会推荐物理治疗。颈部伸展力量锻炼可以改善病情。然而，大多数患者会发现强化锻炼既累人又令人沮丧。当躺下时你可以活动颈部，以保持运动范围。这有助于避免不必要的僵硬和颈前部肌肉的短缩。

Range of motion exercises should be done on an ongoing basis to avoid contractures of the neck. Wearing a neck collar when up will likely improve activities of daily living.

　　应该坚持不断地进行一定范围内的活动锻炼，以避免颈部挛缩。起床后带上颈托可能会改善日常的活动。

Speech therapy may be recommended for swallowing, feeding, and breathing problems. Some people may need to have a feeding tube inserted through the stomach.

　　建议对吞咽，喂食和呼吸问题进行语言治疗。有些人可能需要插入胃管。

Your doctor may want to repeat imaging of the spine. There is the possibility of over stretching or pinching the spinal cord when the neck extensors are so weak. You will need to watch for symptoms such as weakness or numbness in the arms or other portions of the body. Bowel and bladder function could become a problem.

　　你的医生可能会要求你反复检查颈椎的影像。当颈部伸展力量很弱时，存在过度拉伸或压迫脊髓的可能性。你需要注意一些症状，比如手臂或身体其他部位的虚弱或麻木。大小便功能也可能出现问题。

After Surgery

术后康复

If surgery is recommended, you will probably require an overnight hospital stay or a few days stay. Initially, you will not be allowed to lift, and you will have to move carefully. Most likely your neck will be placed in a fairly rigid brace. You will eventually be able to resume your normal activities. You can expect healing of the fusion in three to nine months.

　　如果建议手术，你可能需要住院过夜或住院几天。最初，你不许起床，活动必须小心。你的颈部很可能需要使用非常僵硬的支具。最终你有可能恢复日常的活动。骨头的融合需要三至九个月的时间。

Physical therapy is usually recommended after surgery. Neck extension strengthening exercises are prescribed to prevent contracture of the neck. Occupational therapy may be recommended to help with arm strengthening. It can also help with dressing, and other activities of daily living. Equipment needs can be evaluated by the occupational therapist. Speech therapy may also be recommended after surgery.

　　手术后也往往推荐物理治疗。进行颈部伸展力量练习可防止颈部挛缩。医生可能会推荐职业治疗以帮助加强手臂力量。这对穿衣和其他日常活动也会有帮助。由职业治疗师进行评估是否需要设备辅助。手术后还推荐进行语言治疗。

Your surgeon will want to follow up with you on a regular basis. Imaging studies may need to be repeated on occasion. Assessment of the fusion is usually done with X-rays.

　　你的外科医生希望能定期对你进行随访，并需要不定期复查影像。通常用X射线对融合进行评估。

翻译：周轶，医学硕士，南通市中医院工作（现在南通市一院参加住院医师规范化培训）。

校对：保国锋

保国锋，南通市第一人民医院脊柱外科，副主任医师，硕士生导师、医学博士。江苏省“333高层次人才”培育对象、南通市医学重点人才、南通市“226高层次人才”培养对象。社会兼职：江苏省医学会骨科分会创伤学组委员、江苏省中西医结合学会骨科分会委员、北美脊柱外科学会(NASS)会员、南通市中西医结合学会骨科分会委员。擅长颈肩腰腿痛、脊柱脊髓损伤、脑瘫等手术治疗。2011年、2014年、2016年曾在澳大利亚Latrobe大学、德国OberlinHaus医院、德国科隆大学医院和韩国首尔国立大学医院（SNUH）研修脊柱外科。

门诊时间：周五全天

（编辑：胡佰文）