Neck Pain
頸痛
頸痛患者指南
簡(jiǎn)介
Neck pain is a common reason people visit their doctor. Neck pain typically doesn’t start from a single injury. Instead, the problem usually develops over time from the stress and strain of daily activities. Eventually, the parts of the spine begin to degenerate. The degeneration can become a source of neck pain.
頸痛是患者就診的常見(jiàn)原因。頸痛通常不是源于單次的損傷，而是在日常生活中長(zhǎng)時(shí)間伸展?fàn)坷饾u發(fā)生的疾病。最終，脊柱的這一部分開(kāi)始退變。退變是頸痛的根源之一。
Knowing how your neck normally works and why you feel pain are important in helping you care for your neck problem. Patients are often less anxious and more satisfied with their care when they have the information they need to make the best decisions about their condition.
了解頸椎正常運(yùn)作和你為什么會(huì)感到疼痛對(duì)于幫助你治療你的頸部疾病非常重要。當(dāng)患者具有對(duì)他們的疾病作出最好的決定所需要的信息時(shí)，他們就不會(huì)很著急，也能得到更滿意的治療。
This document will give you a general overview of neck pain. It should help you understand
本文會(huì)對(duì)頸痛進(jìn)行大致概述，有助于你了解：
· what parts make up the spine and neck
· what causes neck pain
· what tests your doctor may run
· how to decrease your pain and increase your mobility
脊柱和頸椎的結(jié)構(gòu)
引起頸痛的原因
你的醫(yī)生會(huì)做些什么檢查
如何減輕頸痛和改善活動(dòng)。
解剖
What parts make up the cervical spine, and how do they work?
頸椎是怎么構(gòu)成的，他們?nèi)绾喂ぷ鳎?/span>
The human spine is made up of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to form the spinal column. The spinal column is the body’s main upright support.
人體脊柱由24塊脊椎骨構(gòu)成，它們上下堆疊形成脊柱。脊柱是人體直立的主要支撐。
The cervical spine is formed by the first seven vertebrae. Doctors often refer to these vertebrae as C1 to C7. The cervical spine starts where the top vertebra (C1) connects to the bottom edge of the skull. The cervical spine curves slightly inward and ends where C7 joins the top of the thoracic spine. This is where the chest begins.
頸椎由最上面的7塊椎體構(gòu)成。醫(yī)生常把它們稱作C1~C7。頸椎起于最上端的椎體（頸1），與顱底邊緣相聯(lián)結(jié)。頸椎有輕度向前的彎曲，終于頸7與胸段脊柱的最上端相連，該處時(shí)胸部起始處。
Each vertebra is formed by a round block of bone, called avertebral body. A bony ring attaches to the back of the vertebral body. When the vertebrae are stacked on top of each other, the rings form a hollow tube. This bony tube surrounds the spinal cord as it passes through the spine. Just as the skull protects the brain, the bones of the spinal column protect the spinal cord.
每個(gè)脊椎骨由一個(gè)圓柱形的骨塊形成，稱為椎體。椎體后方附有骨環(huán)。當(dāng)脊椎骨上下堆疊，骨環(huán)形成一個(gè)空心的管道。這個(gè)骨性管道在脊髓穿行于脊柱時(shí)包繞在脊髓周圍，就象頭顱骨保護(hù)大腦一樣，脊柱骨保護(hù)著脊髓。
As the spinal cord travels from the brain down through the spine, it sends out nerve branches between each vertebrae called nerve roots. These nerve roots join together to form the nerves that travel throughout the body and form the body’s electrical system. The nerve roots that come out of the cervical spine form the nerves that go to the arms and hands. The thoracic spine nerves go to the abdomen and chest. The nerves coming out of the lumbar (lower) spine go to the organs of the pelvis, the legs, and the feet.
當(dāng)脊髓從大腦向下穿行于脊柱，在每個(gè)椎體之間發(fā)出神經(jīng)分支，稱為神經(jīng)根。這些神經(jīng)根相互連結(jié)形成穿行于身體的神經(jīng)，并形成人體的“電氣系統(tǒng)”。從頸椎發(fā)出的神經(jīng)根形成的神經(jīng)支配到胳膊和手。胸椎的神經(jīng)支配腹部和胸部。腰椎的神經(jīng)支配盆腔臟器、腿和足。
了解頸椎解剖的一種方法是觀察一個(gè)脊髓節(jié)段。每個(gè)脊髓節(jié)段包括由椎間盤(pán)相隔開(kāi)的兩個(gè)脊椎骨，神經(jīng)在該水平從脊髓發(fā)出，小關(guān)節(jié)突關(guān)節(jié)（后述）連結(jié)每個(gè)水平的脊柱。
An intervertebral disc is made of connective tissue. Connective tissue is the material that holds the living cells of the body together. Most connective tissue is made of fibers of a material called collagen. In some cases, the collagen fibers join together to form a structure like a rope. In other cases, the fibers are arranged like a piece of cloth, or knitted materials such as you find in a sweater. The disc is a specialized connective tissue structure that separates the two vertebral bodies of the spinal segment. The disc normally works like a shock absorber. It protects the spine against the daily pull of gravity. It also protects the spine during activities that put strong force on the spine, such as jumping, running, and lifting.
椎間盤(pán)由結(jié)締組織構(gòu)成。結(jié)締組織是將人體活細(xì)胞維系在一起的材料。許多結(jié)締組織由稱作膠原的纖維材料構(gòu)成。有時(shí)，膠原纖維相互交錯(cuò)形成象繩子一樣的結(jié)構(gòu)，有時(shí)，纖維排列得象一塊布，或象你在毛衣上看到的編織材料。椎間盤(pán)是分隔脊髓節(jié)段兩個(gè)椎體的特殊的結(jié)締組織結(jié)構(gòu)。椎間盤(pán)正常起減震器的作用。它保護(hù)脊柱對(duì)抗日常重力作用，也能在比如跳躍、奔跑或舉重等活動(dòng)時(shí)保護(hù)脊柱遭受強(qiáng)大外力。
椎間盤(pán)由兩部組成。中央部分稱為髓核，呈海綿狀，起到減震器的大部分作用。髓核由纖維環(huán)維持在位。纖維環(huán)是包繞髓核的一系列堅(jiān)韌的韌帶環(huán)。韌帶是聯(lián)結(jié)骨與其它骨的堅(jiān)韌的結(jié)締組織。
There are two facet joints between each pair of vertebrae, one on each side of the spine. A facet joint is made up of small, bony knobs that line up along the back of the spine. Where these knobs meet, they form a joint that connects the two vertebrae. The alignment of the facet joints of the cervical spine allows freedom of movement as you bend and turn your neck.
在每?jī)蓚€(gè)椎體之間有兩個(gè)關(guān)節(jié)突關(guān)節(jié)，位于脊柱的兩側(cè)。關(guān)節(jié)突關(guān)節(jié)由排列在脊椎背側(cè)小的骨性突起構(gòu)成。當(dāng)這些突起互相接觸，就構(gòu)成關(guān)節(jié)聯(lián)結(jié)兩個(gè)椎骨。頸椎關(guān)節(jié)突關(guān)節(jié)的排列允許你自由地屈伸旋轉(zhuǎn)活動(dòng)。
The surfaces of the facet joints are covered by articular cartilage. Articular cartilage is a smooth, rubbery material that covers the ends of most joints. It allows the bone ends to move against each other smoothly, without pain.
關(guān)節(jié)突關(guān)節(jié)的表面被覆關(guān)節(jié)軟骨。關(guān)節(jié)軟骨是覆蓋在關(guān)節(jié)末端的光滑有彈性的材料。它使骨端之間光滑無(wú)痛地相互運(yùn)動(dòng)。
Two spinal nerves exit the sides of each spinal segment, one on the left and one on the right. As the nerves leave the spinal cord, they pass through a small bony tunnel on each side of the vertebra, called a neural foramen. (The term used to describe more than one opening is neural foramina.)
每個(gè)脊髓節(jié)段的兩側(cè)分別發(fā)出一根脊神經(jīng)，一根在左，一根在右。當(dāng)神經(jīng)離開(kāi)脊髓，穿過(guò)位于椎骨兩側(cè)的小的骨性通道，稱為椎間孔（neural foramen)，復(fù)數(shù)形式（neural foramina）。
Related Document: A Patient’s Guide to Cervical Spine Anatomy
相關(guān)閱讀：英漢對(duì)照骨科患者指南015：頸椎解剖
相關(guān)視頻：
骨科小病不求醫(yī)050：頸椎解剖（Cervical Spine Anatomy）
骨科小病不求醫(yī)052：脊柱解剖（Spine Anatomy）
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病因
Why do I have neck pain?
我為什么會(huì)頸痛？
There are many causes of neck pain. Doctors are not always able to pinpoint the source of a patient’s pain. Your doctor will make every effort to ensure that your symptoms are not from a serious medical cause, such as cancer or a spinal infection. Below is a brief overview of some of the most common causes of neck pain.
引起頸痛的原因很多。醫(yī)生并不總是能指出病人疼痛的根源。你的醫(yī)生會(huì)盡力確保你的癥狀不是由諸如癌癥或脊柱感染等嚴(yán)重的疾病所引起。以下是引起頸痛最常見(jiàn)原因的概述。
Spondylosis
脊椎病
Most neck problems happen after years of wear and tear on the parts of the cervical spine. At first, these small injuries are not painful. But over time they can add up. Eventually they begin to cause neck pain.
很多頸部問(wèn)題是頸椎多年的磨損撕裂引起的。起先，小的損傷不怎么痛，但小損傷隨著時(shí)間可以累積，最終開(kāi)始引起頸痛。
Doctors sometimes call these degenerative changes in the spine spondylosis. Spondylosis can affect the bones and soft tissues of the spine. However, it is important to know that most problems with spondylosis are a normal part of aging.
醫(yī)生有時(shí)將發(fā)生于脊柱的這些退變性改變稱為脊椎病。脊椎病可影響脊柱的骨和軟組織。認(rèn)識(shí)到脊椎病引起的諸多問(wèn)題是正常老化的一部分很重要。
椎間盤(pán)退變性疾病
The normal aging process involves changes within the intervertebral discs. Repeated stresses and strains weaken the connective tissues that make up a disc. Over time, the nucleus in the center of the disc dries out. When this happens, it loses some of its ability to absorb shock. The annulus also weakens and develops small cracks and tears.
正常老化過(guò)程包括椎間盤(pán)的改變。反復(fù)應(yīng)力拉伸使構(gòu)成椎間盤(pán)的結(jié)締組織變?nèi)?。隨著時(shí)間變化，椎間盤(pán)中央的髓核水分減少，椎間盤(pán)就會(huì)失去一部分減震器的作用。纖維環(huán)也會(huì)變?nèi)?，出現(xiàn)小的裂隙和撕裂。
Often these changes are not painful. But larger tears that reach to the outer edge of the annulus can cause neck pain. The body tries to heal the cracks with scar tissue. But scar tissue is not as strong as the tissue it replaces. At some point the disc may finally lose its ability to absorb shock for the spine. Then forces from gravity and daily activities can take even more of a toll on the disc and other structures of the spine.
通常，這些改變不引起疼痛。但到達(dá)纖維環(huán)外層的巨大的撕裂會(huì)引起頸痛。人體試圖以疤痕組織來(lái)修復(fù)這些裂隙。但疤痕組織不如其所替代的組織那樣堅(jiān)固。最終椎間盤(pán)失去了作為脊柱減震器的能力。于是重力以作日?；顒?dòng)的應(yīng)力會(huì)引起椎間盤(pán)和脊柱其它結(jié)構(gòu)的更大的損失。
觀察退變的動(dòng)畫(huà)
As the disc continues to degenerate, the space between the vertebrae becomes smaller. This compresses the facet joints along the back of the spinal column. As these joints are forced together, extra pressure builds on the articular cartilage on the surface of the facet joints. This extra pressure can damage the facet joints. Over time, this may lead to arthritis in the facet joints.
隨著椎間盤(pán)繼續(xù)退變，椎間隙變得越來(lái)越小，這會(huì)壓迫排除于脊柱后方的關(guān)節(jié)突關(guān)節(jié)。當(dāng)這些關(guān)節(jié)相互受力，在關(guān)節(jié)突關(guān)節(jié)表面的關(guān)節(jié)軟骨就承受額外的壓力。這些額外的壓力會(huì)損傷關(guān)節(jié)突關(guān)節(jié)。隨著時(shí)間變化，這將導(dǎo)致關(guān)節(jié)突關(guān)節(jié)的關(guān)節(jié)炎。
These degenerative changes in the disc, facet joints, and ligaments cause the spinal segment to become loose and unstable. The extra movement causes even more wear and tear on the spine. As a result, more and larger tears occur in the annulus.
椎間盤(pán)、關(guān)節(jié)突關(guān)節(jié)和韌帶的這些退變性改變導(dǎo)致脊髓節(jié)段變得松動(dòng)不穩(wěn)。額外的活動(dòng)引起脊柱更多的磨損和撕裂。其結(jié)果是纖維環(huán)發(fā)生了更多更大的撕裂。
The nucleus may push through the weakened and torn annulus and into the spinal canal. This is called a herniated or ruptured disc. The disc material that squeezes out can press against the spinal nerves. The disc also emits enzymes and chemicals that produce inflammation. The combination of pressure on the nerves and inflammation caused by the chemicals released from the disc cause pain.
髓核會(huì)通過(guò)脆弱和撕裂的纖維環(huán)被擠入到椎管。此所謂椎間盤(pán)疝出或破裂。被擠出的椎間盤(pán)組織會(huì)壓迫脊神經(jīng)。椎間盤(pán)還會(huì)釋放能引起炎癥反應(yīng)的酶和化學(xué)物質(zhì)。神經(jīng)受壓和椎間盤(pán)釋放的化學(xué)物質(zhì)引起的炎癥反應(yīng)共同作用導(dǎo)致疼痛。
隨著退變繼續(xù)，在關(guān)節(jié)突關(guān)節(jié)周圍和椎間盤(pán)周圍出現(xiàn)骨刺。沒(méi)人真正理解為什么會(huì)出現(xiàn)這些骨刺。許多醫(yī)生認(rèn)為骨刺是人體試圖阻止脊髓節(jié)段的額外的活動(dòng)。如果脊神經(jīng)穿過(guò)椎間孔時(shí)被骨刺壓迫就會(huì)引起問(wèn)題。在受累神經(jīng)根周圍的壓迫會(huì)引起頸部、胳膊和手的疼痛、麻木和無(wú)力。
相關(guān)視頻：頸椎間盤(pán)退變性疾?。–ervical Degenerative Disc Disease）
Muscle Strain
肌肉扭傷
People with minor neck pain or stiffness are often told they have a muscle strain. However, unless there was a severe injury to the neck, the muscles probably haven’t been pulled or injured. Instead, the problem may be coming from irritation or injury in other spine tissues, such as the disc or ligaments. When this happens, the neck muscles may go into spasm to help support and protect the sore area.
輕度頸痛和僵硬的病人常被告知他們發(fā)生了肌肉扭傷。然而，除非頸部遭受嚴(yán)重的外傷，肌肉不太可能過(guò)度牽拉或損傷。相反，問(wèn)題可能來(lái)于其他脊椎組織的刺激或損傷，比如椎間盤(pán)或韌帶。當(dāng)出現(xiàn)這種情況時(shí)，頸部的肌肉出現(xiàn)痙攣以幫助支撐和保護(hù)疼痛的區(qū)域。
相關(guān)視頻：頸部扭傷和拉傷
Mechanical Neck Pain
機(jī)械性頸痛
機(jī)械性頸痛由頸部的磨損撕裂引起。它與機(jī)器開(kāi)始磨損性質(zhì)相似。機(jī)械性疼痛通常從椎間盤(pán)退行性改變開(kāi)始。當(dāng)椎間盤(pán)開(kāi)始塌陷，椎間隙變窄，關(guān)節(jié)突關(guān)節(jié)出現(xiàn)炎癥。疼痛往往是慢性的。（慢性疼痛是隨著時(shí)間慢慢形成的并會(huì)持續(xù)很長(zhǎng)時(shí)間）。疼痛往往在頸部，但會(huì)從頸部放射到肩后上方和外側(cè)。機(jī)械性頸痛往往不引起胳膊和手的無(wú)力和麻木，因?yàn)閱?wèn)題不出在脊神經(jīng)受壓。
Radiculopathy (Pinched Nerve)
神經(jīng)根?。ㄉ窠?jīng)壓迫）
頸椎神經(jīng)的受壓和激惹會(huì)影響神經(jīng)的電信號(hào)。神經(jīng)受壓和激惹讓人感到皮膚麻木、肌肉無(wú)力或沿神經(jīng)分布區(qū)域的疼痛。許多人認(rèn)為這個(gè)癥狀提示神經(jīng)受壓。醫(yī)務(wù)人員將這種情況稱為神經(jīng)根型頸椎病。
Several conditions can cause radiculopathy. The most common are degeneration,disc herniation, and spinal instability.
許多情況能引起神經(jīng)根病。最常見(jiàn)的有退行性變、椎間盤(pán)疝出、脊椎不穩(wěn)。
Related Document: A Patient’s Guide to Cervical Radiculopathy
相關(guān)閱讀：
英漢對(duì)照骨科患者指南029：神經(jīng)根型頸椎?。ㄉ希?/a>
英漢對(duì)照骨科患者指南029：神經(jīng)根型頸椎?。ㄏ拢?/a>
相關(guān)視頻：頸椎神經(jīng)根?。–ervical Radiculopathy）
Degeneration: As the spine ages, several changes occur in the bones and soft tissues. The disc loses its water content and begins to collapse, causing the space between the vertebrae to narrow. The added pressure may irritate and inflame the facet joints, causing them to become enlarged. When this happens, the enlarged joints can press against the nerves going to the arm as they squeeze through the neural foramina. Degeneration can also cause bone spurs to develop. Bone spurs may put pressure on nerves and produce symptoms of cervical radiculopathy.
退行性變：隨著脊椎老化，骨和軟組織發(fā)生了很多改變。椎間盤(pán)含水量下降開(kāi)始塌陷，引起椎間隙狹窄。額外的壓力刺激并引起關(guān)節(jié)突關(guān)節(jié)炎癥，導(dǎo)致它們?cè)錾?。此時(shí)，增生的關(guān)節(jié)會(huì)壓迫穿過(guò)椎間孔支配胳膊的神經(jīng)。退變還會(huì)導(dǎo)致骨刺形成。骨刺也會(huì)壓迫神經(jīng)產(chǎn)生神經(jīng)根型頸椎病的癥狀。
相關(guān)視頻：椎間盤(pán)退變性疾病（Degenerative Disc Disease）
Herniated Disc: Heavy, repetitive bending, twisting, and lifting can place extra pressure on the shock-absorbing nucleus of the disc. If great enough, this increased pressure can injure the annulus (the tough, outer ring of the disc). If the annulus ruptures or tears, the material in the nucleus can squeeze out of the disc. This is called a herniation. Although daily activities may cause the nucleus to press against the annulus, the body is normally able to withstand these pressures. However, as the annulus ages, it tends to crack and tear. It is repaired with scar tissue. Over time, the annulus becomes weakened, and the disc can more easily herniate through the damaged annulus.
椎間盤(pán)疝出：用力反復(fù)屈伸、旋轉(zhuǎn)及負(fù)重對(duì)起減震器作有的椎間盤(pán)髓核產(chǎn)生額外壓力。如果壓力太大，增加的壓力會(huì)損傷纖維環(huán)（椎間盤(pán)堅(jiān)韌的外層結(jié)構(gòu)）。如果纖維環(huán)破裂或撕裂，髓核組織會(huì)擠出椎間盤(pán)，此所謂疝出。盡管日常活動(dòng)會(huì)引起髓核壓迫纖維環(huán)，人體通常能夠承受這些壓力。然而，隨著纖維環(huán)老化，它趨于破損撕裂。這些損傷通過(guò)疤痕組織修復(fù)。長(zhǎng)此以往，纖維環(huán)變脆弱，椎間盤(pán)就更容易從受損的纖維環(huán)疝出。
如果疝出的椎間盤(pán)組織壓迫神經(jīng)根會(huì)引起疼痛、麻木和神經(jīng)支配區(qū)域的無(wú)力。這種情況稱作神經(jīng)根型頸椎病（見(jiàn)前述）。有時(shí)，疝出的髓核接觸損傷纖維環(huán)的外層組織，釋放化學(xué)物質(zhì)引起炎癥和疼痛。如果髓核完全從纖維環(huán)疝出，會(huì)壓迫脊髓，將引起更加嚴(yán)重的問(wèn)題，因此它將影響脊髓里所有的神經(jīng)，這種情況稱作脊髓型頸椎病。
相關(guān)視頻：頸椎間盤(pán)突出（cervical herniated disc）
Spinal Instability: Spinal instability means there is extra movement among the bones of the spine. Instability in the cervical spine can develop if the supporting ligaments have been stretched or torn from a severe injury to the head or neck. People with diseases that loosen their connective tissue may also have spinal instability. Spinal instability also includes conditions in which a vertebral body slips over the one just below it. When the vertebral body slips too far forward, the condition is called spondylolisthesis. Whatever the cause, extra movement in the bones of the spine can irritate or put pressure on the nerves of the neck, causing symptoms.
脊椎不穩(wěn)：脊椎不穩(wěn)是指脊椎骨之間出現(xiàn)了額外的活動(dòng)。頸段脊椎不穩(wěn)可因頭部或頸部的嚴(yán)重?fù)p傷造成支持韌帶過(guò)度伸展撕裂引起?；加薪Y(jié)締組織松弛疾病的人也會(huì)發(fā)生脊椎不穩(wěn)。脊椎不穩(wěn)也包括上位椎體相對(duì)于下位椎體發(fā)生滑動(dòng)。當(dāng)椎體過(guò)度向前滑動(dòng)，這種情況稱為脊椎滑脫。無(wú)論何種原因，脊椎骨額外的活動(dòng)會(huì)刺激或壓迫頸部的神經(jīng)引起癥狀。
Spinal Stenosis (Cervical Myelopathy)
椎管狹窄（脊髓型頸椎病）
Stenosis means closed in. Spinal stenosis refers to a condition in which the spinal cord is closed in, or compressed, inside the tube of the spinal canal. Spinal stenosis may be caused by degenerative changes, such as bone spurs pushing against the spinal cord within the spinal canal.
狹窄意指被包圍。椎管狹窄是指脊髓在椎管內(nèi)被包圍或壓迫的一種情況。椎管狹窄可因退變性改變所引起，比如骨刺在椎管內(nèi)對(duì)脊髓造成壓迫。
However, stenosis can also develop when a person of any age has a disc herniation that pushes against the spinal canal. When the spinal cord is squeezed in the neck, doctors call the condition cervical myelopathy.
當(dāng)然，椎管狹窄也可因椎間盤(pán)疝出壓迫脊髓，可發(fā)生于任何年齡的人。當(dāng)脊髓在頸部受擠壓，醫(yī)生將這種情況稱作脊髓型頸椎病。
This is an alarming condition that demands medical attention. Cervical myelopathy can cause problems with the bowels and bladder, change the way you walk, and affect your ability to use your fingers and hand.
這是需要引起醫(yī)學(xué)關(guān)注的危險(xiǎn)情況。脊髓型頸椎病可引起大小便的障礙，行走困難以及影響手指和手的功能。
相關(guān)視頻：頸椎管狹窄伴脊髓?。–ervical spinal stenosis with myelopathy）
（胡佰文 譯）
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