腰椎間盤突出
腰椎間盤突出患者指南
治療
What treatment options are available?
有什么治療方式可以選擇？
非手術治療
Unless your condition is causing significant problems or is rapidly getting worse, most doctors will begin with nonsurgical treatment.
除非患者的椎間盤突出對生活造成了嚴重影響或迅速惡化，大部分醫(yī)生都會對患者進行非手術治療。
At first, your doctor may want your low back immobilized. Keeping the back still for a short time can calm inflammation and pain. This might include one or two days of bed rest. Lying on your back can take pressure off sore discs and nerves. However, most doctors advise against strict bed rest and prefer their patients to do ordinary activities using pain to gauge how much is too much. In rare cases in which bed rest is prescribed, it is usually used for a maximum of two days.
起初，醫(yī)生希望腰部制動，短時間保持腰部靜止可以緩解炎癥和疼痛。這一過程包括1~2天的臥床休息。仰臥可以減輕椎間盤以及神經(jīng)上的壓力。然而大部分醫(yī)生反對絕對臥床，而是建議病人繼續(xù)進行日?；顒?，以疼痛為標準判斷多少活動合適。在極少的病例中患者需要絕對臥床休息，但這樣的休息一般不超過2天。
A back support belt is sometimes used for patients with lumbar disc herniation. The belt can help lower pressure inside the problem disc. Patients are encouraged to gradually discontinue wearing the support belt over a period of two to four days. Otherwise, their trunk muscles begin to rely on the belt and start to atrophy(shrink).
一些腰椎間盤突出患者可以使用腰部支撐帶。腰部支撐帶可以降低患病椎間盤內的壓力。一般建議患者在2~4天的時間內間斷佩戴腰部支撐帶。否則，身體肌肉將會對腰圍產(chǎn)生依賴而開始發(fā)生萎縮。
Doctors prescribe certain types of medication for patients with lumbar disc herniation. At first, you may be prescribed anti-inflammatory medications such as aspirin or ibuprofen. Severe symptoms that don’t go away may be treated with narcotic drugs, such as codeine or morphine. But narcotics should only be used for the first few days or weeks because they are addictive when used too much or improperly. Muscle relaxants may be prescribed if the low back muscles are in spasm. Pain that spreads down the leg is sometimes relieved with oral steroids taken in tapering dosages.
醫(yī)生會給患者開具一些處方藥物。首先，醫(yī)生將會使用一些抗炎藥物，如阿司匹林或布洛芬。鎮(zhèn)痛藥物可被用于無法緩解的嚴重癥狀，如可待因或嗎啡。但是鎮(zhèn)痛藥只能在數(shù)天或數(shù)周內短暫使用，因為當患者不恰當或過度使用鎮(zhèn)痛藥時會對其上癮。當腰部肌肉痙攣時，可以使用肌松劑。當疼痛放射至腿部時，可以使用口服激素，但激素需要逐漸減量。
You may work with a physical therapist. Therapy treatments focus on relieving pain, improving back movement, and fostering healthy posture. A therapist can design a program to help you prevent future problems.
您也可尋求物理治療師治療。物理治療致力于緩解疼痛，改善背部運動，培養(yǎng)健康的姿勢。物理治療師會為患者設計一個方案以預防日后的問題。
Some patients who continue to have symptoms are given an epidural steroid injection (ESI). Steroids are powerful anti-inflammatories. In an ESI, medication is injected into the space around the lumbar spinal nerves where they branch off of the spinal cord. This area is called the epidural space. Some doctors inject only a steroid. Most doctors, however, combine a steroid with a long-lasting numbing medication. Generally, an ESI is given only when other treatments aren’t working. But ESIs are not always successful in relieving pain. If they do work, they often provide only temporary relief.
一些癥狀持續(xù)的病人可以進行硬膜外激素注射。激素是強有力的抗炎藥。硬膜外激素注射是將藥物注射入脊髓分出腰脊神經(jīng)的分叉處的間隙，這一間隙被稱為硬膜外腔。有些醫(yī)生只注射激素。然而大部分醫(yī)生會將激素和長效局麻藥聯(lián)合使用。硬膜外注射一般只在其他治療無效時使用，但它也并非總是能夠緩解疼痛。就算硬膜外注射確實有效，一般也只能達到暫時的鎮(zhèn)痛效果。
Most people with a herniated lumbar disc get better without surgery. As a result, doctors usually have their patients try nonoperative treatments for at least six weeks before considering surgery. But when patients simply aren’t getting better, or if the problem is becoming more severe, surgery may be suggested.
大部分腰椎間盤突出患者經(jīng)非手術治療后好轉。因此，醫(yī)生通常建議患者在考慮手術之前進行至少6周的保守治療。但是當患者病情始終無法好轉甚至惡化時，就需要進行手術。
手術
If the symptoms you feel are mild and there is no danger they’ll get worse, surgery is not usually recommended. However, if signs appear that pressure is building on the spinal nerves, surgery may be required, sometimes right away. The signs doctors watch for when reaching this decision include weakening in the leg muscles, pain that won’t ease up, and problems with the bowels or bladder.
若患者只有輕中度的癥狀且沒有加重的風險，一般不建議手術。但是當癥狀提示脊神經(jīng)受到壓迫時一般需要進行手術，有時還需要進行急診手術。一般此時會出現(xiàn)下肢肌肉無力，疼痛不能緩解，以及出現(xiàn)大小便障礙。
Surgical treatment for lumbar disc herniation includes
· laminotomy and discectomy
· microdiscectomy
腰椎間盤突出的外科治療包括
· 椎板切開術和椎間盤切除術
· 顯微椎間盤摘除術
· 后路腰椎融合術
Laminotomy and Discectomy
椎板切開術和椎間盤切除術
The lamina forms a roof-like structure over the back of the spinal canal. In this procedure, a thumbnail-sized piece of the lamina is removed (laminotomy) so the surgeon can more easily take out the problem disc (discectomy). This procedure is mainly used when the herniated disc is putting pressure on a nerve and causing pain to spread down one leg.
椎板是椎管后方的屋頂樣結構。手術中需要切除大拇指指甲大小的椎板（椎板切開術），醫(yī)生才能更容易地清除病變的椎間盤（椎間盤切除術）。這一術式一般用于突出的椎間盤壓迫神經(jīng)產(chǎn)生疼痛并放射至一側下肢時。
Related Document: A Patient’s Guide to Lumbar Discectomy
相關閱讀：腰椎間盤切除術患者指南（翻譯招募中，有意者請留言）
Microdiscectomy
顯微椎間盤摘除術
Microdiscectomy is becoming the standard surgery for lumbar disc herniation. The procedure is used when a herniated disc is putting pressure on a nerve root. It involves carefully taking out part of the problem disc (discectomy). By performing the operation with a surgical microscope, the surgeon only needs to make a very small incision in the low back. Categorized as minimally invasive surgery, this surgery is thought to be less taxing on patients. Advocates also believe that this type of surgery is easier to perform, that it prevents scarring around the nerves and joints, and that it helps patients recover more quickly.
顯微椎間盤摘除術逐漸成為治療腰椎間盤突出的標準術式。這一術式一般在突出的椎間盤壓迫神經(jīng)根時使用。手術時，需要小心地移除部分病變椎間盤（椎間盤摘除術）。通過顯微鏡進行手術，醫(yī)生在腰部只要切一個很小的切口。微創(chuàng)手術對病人造成傷害較小。提倡者還認為這種術式更易于操作，防止神經(jīng)和關節(jié)周圍的瘢痕形成，同時也能幫助病人更快的恢復。
Posterior Lumbar Fusion
后路椎體融合術
Lumbar disc herniation causes mechanical pain, the type of pain caused by wear and tear in the parts of the lumbar spine. Fusion surgery is mainly used to stop movement of the painful area by joining two or more vertebrae into one solid bone. This keeps the bones and joints from moving, easing mechanical pain.
腰椎間盤突出使腰椎的部分結構磨損和撕裂，導致機械性疼痛。融合手術將兩節(jié)或更多節(jié)椎體融合成一節(jié)防止疼痛部位相對運動。通過使骨頭和關節(jié)無法相對運動來緩解疼痛。
In posterior lumbar fusion, the surgeon lays small grafts of bone over the problem area on the back of the spinal column. Most surgeons will also apply metal plates and screws to prevent the problem vertebrae from moving. This protects the graft so it can heal better and faster.
在后路椎體融合術中，醫(yī)生會把一小塊移植骨放置在脊柱后方的病變區(qū)域。大部分外科醫(yī)生也會使用金屬板以及螺釘來防止病變椎體間移動。這些金屬板以及螺釘保護植骨塊，使之能夠更好更快地愈合。
Related Document: A Patient’s Guide to Posterior Lumbar Fusion
相關閱讀：后路腰椎融合術患者指南（翻譯招募中，有意者請留言）
康復
What should I expect as I recover?
恢復過程中我應該怎么做？
非手術治療的康復
Even if you don’t need surgery, your doctor may recommend that you work with a physical therapist. Patients are normally seen a few times each week for four to six weeks. In severe cases, patients may need a few additional weeks of care.
即使您不需要進行手術，醫(yī)生也會建議您尋求物理治療師的幫助。一般建議4~6周每周數(shù)次的物理治療。在嚴重的病例中，患者可能需要額外幾周進行康復。
The first goal of treatment is to control symptoms. Your therapist will help you find positions and movements that ease pain. Treatments of heat, cold, ultrasound, and electrical stimulation may be used in the first few sessions. Lumbar traction may also be used at first to ease symptoms of lumbar disc herniation. In addition, your therapist may use hands-on treatments such as massage or spinal manipulation. These forms of treatment are mainly used to help reduce pain and inflammation so you can resume normal activity as soon as possible.
治療的首要目標是控制癥狀。物理治療師會幫助病人尋找到能夠緩解疼痛的正確姿勢和動作。在開始治療階段，可能應用熱療、冷療，超聲治療以及電刺激治療。開始時也可用腰椎牽引來緩解腰椎間盤突出帶來的癥狀。除此之外，治療師也會進行一些手法治療，例如按摩和脊柱推拿。這些治療主要用來緩解疼痛和炎癥，以幫助病人盡早恢復日?；顒?。
The therapist shows you how to keep your spine safe during routine activities. You’ll learn about healthy posture and how posture relates to the future health of your spine. You’ll learn about body mechanics, how the body moves and functions during activity. Therapists teach safe body mechanics to help you protect the low back as you go about your day. This includes the use of safe positions and movements while lifting and carrying, standing and walking, and performing work duties.
物理治療師會教導病人如何在日常生活中保護脊椎?；颊邥W習關于如何保持健康的姿勢，以及姿勢如何影響脊椎將來的健康?；颊咄瑫r還會了解機體的運轉機制，如機體在活動中如何移動以及運作。治療師會講授安全的人體力學機制，以幫助您在日常生活中保護腰部，包括在提重物、搬重物，站立、行走，實施工作任務時采取安全的姿勢和動作。
Next comes a series of strengthening exercises for the abdominal and low back muscles. Working these core muscles helps patients begin moving easier and lessens the chances of future pain and problems.
接下來患者需要進行一系列腹部肌肉和腰部肌肉的強化練習。鍛煉這些核心肌群可以幫助病人開始更容易活動，并減少將來疼痛和其它病變的概率。
Aerobic exercises such as walking or swimming are used for easing pain and improving endurance.
有氧運動例如散步或游泳用于緩解疼痛以及增強耐力。
Your therapist will work closely with your doctor and employer to help you get back on the job as quickly as reasonably possible. You may be required to do lighter duties at first, but as soon as you are able, you’ll begin doing your normal work activities. Your therapist can do a work assessment to make sure you’ll be safe to do your job. Your therapist may suggest changes that could help you work safely, with less chance of re-injuring your back.
治療師會與您的醫(yī)生和老板密切合作來幫助您盡早合理地恢復工作?；颊邉傞_始可能需要減輕工作負荷，但是當恢復恰當后即可開始正常工作。治療師會對您進行評估以確保您能夠安全地工作，同時也會建議作些改變以確保您能夠安全工作，減小日后腰部再次受傷的風險。
A primary purpose of therapy is to help you learn how to take care of your symptoms and prevent future problems. You’ll be given a home program of exercises to continue improving flexibility, posture, endurance, and low back and abdominal strength. The therapist will also discuss strategies you can use if your symptoms flare up.
康復治療的最主要目標是幫助患者了解如何緩解癥狀以及預防未來的病變。患者一般會被要求在家進行鍛煉來持續(xù)改善柔韌性，姿勢，耐力以及腰部和腹部的力量。治療師也會在您癥狀突然加重時討論應對策略。
術后康復
Rehabilitation after surgery is more complex. Some patients leave the hospital shortly after surgery. However, some surgeries require patients to stay in the hospital for a few days. Patients who stay in the hospital may visit with a physical therapist in the hospital room soon after surgery. The treatment sessions help patients learn to move and do routine activities without putting extra strain on the back.
手術后的康復更為復雜。一些病人在術后短期內出院，但是有一些醫(yī)生要求病人住院一段時間。住院病人在手術后很快可以在病房里尋求物理治療師。這個治療階段幫助患者學習在不增加腰部額外負荷的情況下進行運動和日常活動。
During recovery from surgery, patients should follow their surgeon’s instructions about wearing a back brace or support belt. They should be cautious about overdoing activities in the first few weeks after surgery.
在術后康復過程中，患者必須遵從醫(yī)生的指導，例如佩戴腰部支具或支撐帶?；颊咴谛g后的幾個星期內必須避免過度活動。
Many surgical patients need physical therapy outside of the hospital. They see a therapist for one to three months, depending on the type of surgery. At first, therapists may use treatments such as heat or ice, electrical stimulation, massage, and ultrasound to help calm pain and muscle spasm. They provide reassurance to help patients deal with fear and apprehension about pain. Then they teach patients how to move safely with the least strain on the healing back. Exercises are used to improve flexibility, strength, and endurance.
許多手術病人出院后仍需要物理治療。根據(jù)手術的方式，患者需要進行1~3個月的時間的物理治療。治療師首先會使用熱療、冰敷，電刺激，按摩以及超聲波等治療幫助緩解疼痛和肌肉痙攣。他們能夠幫助病人消除對疼痛的恐懼，增進對疼痛的了解。然后治療師會教導病人如何減少正在愈合的腰部受力進行安全的活動。患者需要進行鍛煉來增進柔韌性、力量及耐力。
When your treatment is well under way, regular visits to the therapist’s office will end. The therapist will continue to be a resource for you. But you will be in charge of doing your exercises as part of an ongoing home program.
當您的康復治療順利進行時，定期尋求治療師就可結束。當然治療師依然是您的資源。但您需要自己負責做康復鍛煉，并成為今后居家的一部分。
（洪瀾 譯 胡佰文 校）
洪瀾，女，浙江大學醫(yī)學院臨床醫(yī)學專業(yè)學生，已被復旦大學錄取為神經(jīng)內科研究生。
患者指南，圖文并茂，
分門別類，構思巧妙。
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，
以利再版，更加周到。
聯(lián)系客服
