Cervical Corpectomy and Strut Graft頸椎椎體次全切除術(shù)和支撐植骨術(shù) A Patient’s Guide to Cervical Corpectomy and Strut Graft
頸椎椎體次全切除術(shù)和支撐植骨術(shù)患者指南Complications并發(fā)癥 What might go wrong? 會有什么并發(fā)癥？ As with all major surgical procedures, complications can occur. Some of the most common complications following corpectomy surgery include 所有主要的外科手術(shù)，都可能出現(xiàn)并發(fā)癥。椎體次全切除術(shù)的并發(fā)癥主要包括以下幾個方面： · problems with anesthesia · thrombophlebitis · infection · nerve damage · problems with the graft or hardware · nonunion · ongoing pain
This is not intended to be a complete list of the possible complications, but these are the most common. 這里沒有列出所有可能發(fā)生的并發(fā)癥，但這些是最常見的。 Problems with Anesthesia 麻醉風(fēng)險 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. 手術(shù)過程中麻醉藥品與病人服用的其他藥物產(chǎn)生反應(yīng)時，可能會出現(xiàn)問題。在罕見的情況下，病人會對麻醉藥物本身產(chǎn)生反應(yīng)。此外，麻醉會影響肺功能，因為麻醉時肺部不能像平時一樣很好的擴(kuò)張。一定要和麻醉師討論麻醉風(fēng)險及你所關(guān)注的問題。 Thrombophlebitis (Blood Clots) 血栓性靜脈炎（凝血塊） View animation of pulmonary embolism （原文動畫無法下載，從網(wǎng)上找了幾個相關(guān)視頻） 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 血栓性靜脈炎，有時被稱為深靜脈血栓，在任何一個手術(shù)之后都可能發(fā)生。當(dāng)腿部的大靜脈中血液形成凝血塊時發(fā)生。它會導(dǎo)致腿部的腫脹，皮溫升高和疼痛。如果凝血塊從靜脈中脫落，它可以轉(zhuǎn)移到肺部，阻塞肺部的毛細(xì)血管，阻斷一部分肺的血供。這被稱為肺栓塞。絕大多數(shù)的外科醫(yī)生都非常認(rèn)真地預(yù)防下肢深靜脈血栓。有很多的方法可降低發(fā)生下肢深靜脈血栓的風(fēng)險，但是最有效的方法是讓你盡快的下床活動。另外兩種常用的預(yù)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
Infection 感染 Infection following spine surgery is rare but can be a very serious complication. Some infections may show up very early, even before you leave the hospital. 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 and may require additional surgery to treat the infected portion of the spine. Your surgeon may give you antibiotics before spine surgery when the procedure requires bone grafts or hardware (plates, rods, or screws). 脊柱術(shù)后的感染是非常少見的，但是一旦反生會導(dǎo)致很嚴(yán)重的并發(fā)癥。有些感染會很早的表現(xiàn)出來，甚至是在你出院之前。皮膚表面的感染通常可以使用抗生素來治愈。脊柱深部累及到骨和軟組織的感染很難被治愈，并可能需要額外的手術(shù)來治療感染的脊柱部位。如果你的手術(shù)需要植骨或者內(nèi)固定（鋼板，棒或者螺釘），你的外科醫(yī)生會在脊柱手術(shù)前會給你使用抗生素。 Nerve Damage 神經(jīng)損傷 Any surgery that is done near the spinal canal can potentially cause injury to the spinal cord or spinal nerves. Injury can occur from bumping or cutting the nerve tissue with a surgical instrument, from swelling around the nerve, or from the formation of scar tissue. An injury to these structures can cause muscle weakness and a loss of sensation to the areas supplied by the nerve. 靠近椎管的任何手術(shù)都有可能導(dǎo)致脊髓或者脊神經(jīng)的損傷。在腫脹的神經(jīng)組織周圍，手術(shù)器械對神經(jīng)的碰撞或者切斷神經(jīng)組織都會導(dǎo)致?lián)p傷的發(fā)生。這些結(jié)構(gòu)的損傷會導(dǎo)致相應(yīng)支配區(qū)域的肌肉萎縮和感覺的喪失。 The nerve to the voice box is sometimes injured during surgery on the front of the neck. Surgeons usually prefer to do surgery on the left side of the neck where the path of the nerve is more predictable than on the right side. During surgery, the nerve may be stretched too far when retractors are used to hold the muscles and soft tissues apart. When this happens, patients may be hoarse for a few days or weeks after surgery. In rare cases in which the nerve is actually cut, patients may end up with ongoing minor problems of hoarseness, voice fatigue, or difficulty making high tones. 經(jīng)前路的手術(shù)有時會損傷支配發(fā)聲的神經(jīng)。外科醫(yī)生通常會選擇從左側(cè)的頸部而非右側(cè)進(jìn)行手術(shù)，因為左側(cè)的神經(jīng)走形更容易把握。手術(shù)過程中，肌肉和軟組織被牽引器牽開使得神經(jīng)被拉伸變長。當(dāng)這種情況發(fā)生時，病人會在術(shù)后的幾天或者幾周內(nèi)出現(xiàn)聲音的嘶啞。在很少見的情況下，如果神經(jīng)確實被切斷，病人最終可能會一直有聲音嘶啞、發(fā)音疲勞或者難以發(fā)出高音調(diào)的聲音等小問題。 Problems with the Graft or Hardware 移植物或者內(nèi)固定的問題 Corpectomy surgery requires bone to be grafted into the spinal column. The graft is taken from either the top rim of the pelvis or, more commonly, from the fibula bone along the outside of the lower leg. There is a risk of having pain, infection, or weakness in the area where the graft is taken. 椎體次全切除手術(shù)需要植骨來填充被切除的椎體的區(qū)域。移植骨通常選用骨盆頂部的邊緣或者更常見的選用小腿外側(cè)的腓骨。這會引起疼痛，感染，供區(qū)骨質(zhì)被移除而薄弱的問題。 After the graft is placed, the surgeon checks the position of the graft before completing the surgery. However, the graft may shift slightly soon after surgery to the point it is no longer able to hold the spine stable. When the graft migrates out of position, it may cause injury to the nearby tissues. When the graft shifts out of place, a second surgery may be needed to align the graft and apply more hardware to hold it firmly in place. 移植術(shù)后，外科醫(yī)生會在完成整個手術(shù)前確認(rèn)移植骨的位置。然而，移植術(shù)后可能會有輕微的位置變化，這會使得移植骨不能保持脊柱的穩(wěn)定。當(dāng)移植骨偏離正確的位置，它會損傷周圍的組織。當(dāng)移植骨脫出時，需要二次手術(shù)來擺放移植骨的位置并使用更多的內(nèi)固定將其牢牢地固定在正確的位置上。 Hardware can also cause problems. Screws or pins may loosen and irritate the nearby soft tissues. Also, the metal plates can sometimes break. The surgeon may suggest another surgery either to take out the hardware or to add more hardware to solve the problem. 內(nèi)固定材料也會出現(xiàn)問題。螺釘或者針可能會松動然后會刺激周圍的組織。同時，鋼板有時候可能出現(xiàn)斷裂。外科醫(yī)生可能會建議再進(jìn)行手術(shù)取出內(nèi)固定或者增加更多的內(nèi)固定來解決這些問題。
Nonunion 骨不連 Sometimes the bones do not fuse as planned. This is called anonunion, or pseudarthrosis. (The term pseudarthrosis means false joint.) If the joint motion from a nonunion continues to cause pain, you may need a second operation. 有時候骨折不象預(yù)期那樣愈合。這被稱為骨不連或者假關(guān)節(jié)（這個詞意味著錯誤的關(guān)節(jié)）。如果骨不連的關(guān)節(jié)運動引起持續(xù)的疼痛，你可能需要進(jìn)行二次手術(shù)。 In the second procedure, the surgeon usually adds more bone graft. If hardware was used in the first surgery, the surgeon will check to make sure it is attached firmly. Hardware may also be added to secure the bones so they will fuse together. 在二次手術(shù)中，外科醫(yī)生通常增加移植骨的量。如果第一次手術(shù)使用內(nèi)固定，外科醫(yī)生會檢查它以確保它固定在位。內(nèi)固定同時會固定骨骼，使得它們?nèi)诤显谝黄稹?/span> Ongoing Pain 持續(xù)的疼痛 Corpectomy is a complex surgery. Not all patients feel complete pain relief with this procedure. The main goal of this surgery is to get pressure off the spinal cord and to try and prevent further problems. As with any surgery, you should expect some pain afterward. If the pain continues or becomes unbearable, talk to your surgeon about treatments that can help control your pain. 椎體次全切除術(shù)是一個復(fù)雜的手術(shù)。不是所有的病人都可以從此術(shù)式中解除痛苦。這個手術(shù)的主要目的是解除脊髓的壓迫以及防止遠(yuǎn)期的癥狀出現(xiàn)。和其他手術(shù)一樣，你會出現(xiàn)術(shù)后的疼痛。如果疼痛持續(xù)并且不能忍受，告訴你的外科醫(yī)生，他會幫助你緩解你的疼痛。 After Surgery術(shù)后 What happens after surgery? 術(shù)后會發(fā)生什么？ Most patients are placed in a rigid neck brace or a halo vest, for a minimum of three months after surgery. These restrictive measures may not be needed if the surgeon attached metal hardware to the spine during the surgery. 大多數(shù)病人術(shù)后最少佩戴3個月的硬性頸托或者頭頸胸背心。如果醫(yī)生在術(shù)中使用了內(nèi)固定材料，這些限制性的措施可能就不需要了。 Patients usually stay in the hospital after surgery for up to one week. During this time, a physical therapist will schedule daily sessions to help patients learn safe ways to move, dress, and do activities without putting extra strain on the neck. 病人術(shù)后通常住在醫(yī)院一周。在此期間，物理治療師會安排一個每日的日程來幫助病人安全的進(jìn)行行走、起居以及不額外增加頸部壓力的活動。 Patients are able to return home when their medical condition is stable. However, they are usually required to keep their activities to a minimum in order to give the graft time to heal. Outpatient physical therapy is usually started five weeks after the date of surgery. 當(dāng)病人的情況穩(wěn)定后就能出院回家。然而，他們通常需要限制活動以便移植骨的愈合。門診的物理治療通常是在術(shù)后5周開始的。
Rehabilitation康復(fù) What should I expect during my recovery? 術(shù)后康復(fù)預(yù)期能達(dá)到怎樣的目標(biāo)？ Rehabilitation after corpectomy surgery can be a slow process. You will probably need to attend therapy sessions for two to three months, and you should expect full recovery to take up to one year. 椎體次全切除術(shù)后的康復(fù)是個漫長的過程。你可能需要2到3個月的治療，完全康復(fù)需要1年的時間。 Many surgeons prescribe outpatient physical therapy beginning a minimum of five weeks after surgery. At first, treatments are used to help control pain and inflammation. Ice and electrical stimulation treatments are commonly used to help with these goals. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain. 許多的外科醫(yī)生會在術(shù)后的5周開始門診的物理治療。首先，治療會用于控制疼痛和炎癥。冰敷和電刺激是有助于達(dá)到這些目標(biāo)的常用治療方法。你的治療師可能也會使用按摩或者其他的治療手法來緩解肌肉痙攣和疼痛。 Active treatments are slowly added. These include exercises for improving heart and lung function. Walking, stationary cycling, and arm cycling are ideal cardiovascular exercises. Therapists also teach specific exercises to help tone and control the muscles that stabilize the neck and upper back. 積極的治療措施循序漸進(jìn)。這些措施包括改善心肺功能的練習(xí)。步行、原地騎車和手臂自行車是理想的心血管運動方式。治療師還會教你特殊的訓(xùn)練方式來幫助你的發(fā)音，控制你的肌肉以及穩(wěn)定你的頸部和上背部。
Your therapist also works with you on how to move and do activities. This form of treatment, called body mechanics, is used to help you develop new movement habits. This training helps you keep your neck in safe positions as you go about your work and daily activities. At first, this may be as simple as helping you learn how to move safely and easily in and out of bed, how to get dressed and undressed, and how to do some of your routine activities. Then you’ll learn how to keep your neck safe while you lift and carry items and as you begin to do other heavier activities. 你的治療師會跟你一起工作教你如何行走和活動。這種形式的治療，被稱為人體力學(xué)，用來幫助你養(yǎng)成新的運動習(xí)慣。這些訓(xùn)練有助于你在工作和日常活動中使你的頸部在安全的位置上。首先，他可能會幫助你學(xué)會一些簡單動作，比如怎樣安全地上床和下床、穿衣和脫衣、以及怎樣做一些日常活動。然后你會學(xué)習(xí)到在如何保證你的頸部安全下從事一些重的活動時候，比如拎起一些東西。 As your condition improves, your therapist will tailor your program to help prepare you to go back to work. Some patients are not able to go back to a previous job that requires heavy and strenuous tasks. Your therapist may suggest changes in job tasks that enable you to go back to your previous job. You’ll learn new ways to do these tasks to keep your neck safe and free of extra strain. 隨著你狀況的改善，你的治療師會調(diào)整你的計劃來幫助你回到工作中去。一些病人不能回到先前那種繁重和費力的工作中去。你的治療師會建議改變一些工作任務(wù)，使得你能重新回到以前的工作崗位。你會學(xué)習(xí)到新的方法來完成這些任務(wù)以保證你頸部的安全，不帶來額外的扭傷。 Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems. 在你的治療日程結(jié)束前，你的治療師會教會你一些方法來避免以后可能出現(xiàn)的問題。 翻譯：周軼，醫(yī)學(xué)碩士，南通市中醫(yī)院工作（現(xiàn)在南通市一院參加住院醫(yī)師規(guī)范化培訓(xùn)）。 校對：保國鋒 保國鋒，南通市第一人民醫(yī)院脊柱外科，副主任醫(yī)師，碩士生導(dǎo)師、醫(yī)學(xué)博士。江蘇省“333高層次人才”培育對象、南通市醫(yī)學(xué)重點人才、南通市“226高層次人才”培養(yǎng)對象。社會兼職：江蘇省醫(yī)學(xué)會骨科分會創(chuàng)傷學(xué)組委員、江蘇省中西醫(yī)結(jié)合學(xué)會骨科分會委員、北美脊柱外科學(xué)會(NASS)會員、南通市中西醫(yī)結(jié)合學(xué)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(shù)治療。2011年、2014年、2016年曾在澳大利亞Latrobe大學(xué)、德國OberlinHaus醫(yī)院、德國科隆大學(xué)醫(yī)院和韓國首爾國立大學(xué)醫(yī)院（SNUH）研修脊柱外科。 門診時間：周五全天
患者指南，圖文并茂， 分門別類，構(gòu)思巧妙。 深入淺出，中英對照， 醫(yī)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(dǎo)， 以利再版，更加周到。 |
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