腰椎關(guān)節(jié)突關(guān)節(jié)炎
A Patient’s Guide to Lumbar Facet Joint Arthritis
腰椎關(guān)節(jié)突關(guān)節(jié)炎患者指南
Arthritis of the lumbar facet joints can be a source of significant low back pain. Aligned on the back of the spinal column, the facet joints link each vertebra together.Articular cartilage covers the surfaces where these joints meet. Like other joints in the body that are covered with articular cartilage, the lumbar facet joints can be affected by arthritis.
腰椎關(guān)節(jié)突關(guān)節(jié)炎可導(dǎo)致顯著的下腰痛。關(guān)節(jié)突整齊排列在脊柱背側(cè)，將每個(gè)椎骨連接起來(lái)。關(guān)節(jié)突相到接觸的地方有關(guān)節(jié)軟骨在表面覆蓋。就如身體上其他覆蓋關(guān)節(jié)軟骨的關(guān)節(jié)一樣，腰椎關(guān)節(jié)突關(guān)節(jié)也會(huì)得關(guān)節(jié)炎。
This guide will help you understand
本指南將有助于你理解以下幾點(diǎn)：
· how the problem develops
· 關(guān)節(jié)突關(guān)節(jié)炎如何變化進(jìn)展？
· how doctors diagnose the condition
· 臨床醫(yī)生如何診斷？
· what treatment options are available
· 可行的治療有哪些？
What part of the back is involved?
病變發(fā)生在腰背部的哪個(gè)位置？
The human spine is made up of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to create the spinal column. The spinal column gives the body its form. It is the body’s main upright support.
人體的脊柱是由24塊脊柱骨塊組成，我們稱(chēng)之為椎骨。椎骨彼此上下堆疊構(gòu)成脊柱。脊柱塑造了人體的大致形態(tài)。脊柱是維持人體直立位的主要支撐。
The back portion of the spinal column forms a bony ring. When the vertebrae are stacked on top of each other, these bony rings create a hollow tube. This tube, called the spinal canal, 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.
脊柱的背側(cè)部分構(gòu)成一個(gè)骨性環(huán)。當(dāng)椎骨彼此上下堆疊的時(shí)候這些骨性環(huán)也就組成了一個(gè)中空的管道，我們稱(chēng)之為椎管。它圍繞貫穿脊柱的脊髓。就好像顱骨保護(hù)大腦一樣，脊柱的骨性結(jié)構(gòu)保護(hù)著脊髓。
Between the vertebrae of each spinal segment are two facet joints. The facet joints are located on the back of the spinal column. There are two facet joints between each pair of vertebrae, one on each side of the spine. A facet joint is made 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 lumbar spine allows freedom of movement as you bend forward and back.
在每個(gè)脊柱節(jié)段的椎骨之間有兩個(gè)關(guān)節(jié)突。關(guān)節(jié)突位于脊柱的背側(cè)。位于每一對(duì)椎骨之間的兩個(gè)關(guān)節(jié)突各在脊柱的一側(cè)。關(guān)節(jié)突是由骨性小突起組成，它們排列在脊柱后方。這些突起相接觸的地方形成關(guān)節(jié)突關(guān)節(jié)，以連接兩個(gè)椎骨。脊柱關(guān)節(jié)突的排列使你能都自由的前后彎腰活動(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 friction.
關(guān)節(jié)突的表面覆蓋有關(guān)節(jié)軟骨，關(guān)節(jié)軟骨是覆蓋在大部分關(guān)節(jié)末端的光滑而又彈性的物質(zhì)。它使得骨端能沒(méi)有摩擦地相對(duì)滑動(dòng)。
Related Document: A Patient’s Guide to Lumbar Spine Anatomy
相關(guān)閱讀：腰椎解剖患者指南（翻譯招募中，有意者請(qǐng)留言）
精美視頻：腰椎解剖（lumbar spine anatomy）
警告：請(qǐng)?jiān)谟蠾IFI的場(chǎng)所觀看視頻，土豪請(qǐng)隨意。
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Why do I have this problem?
為什么我會(huì)患有關(guān)節(jié)突關(guān)節(jié)炎？
Normally, the facet joints fit together snugly and glide smoothly, without pressure. If pressure builds where the joint meets, the cartilage on the joint surfaces wears off, or erodes.
正常情況下，關(guān)節(jié)突緊貼在一起，在沒(méi)有應(yīng)力的條件下滑動(dòng)。一旦在關(guān)節(jié)突接觸點(diǎn)應(yīng)力增加，關(guān)節(jié)突表面的軟骨就會(huì)磨損，侵蝕。
Each segment in the spine has three main points of movement, the intervertebral disc and the two facet joints. Injury or problems in any one of these structures affects the other two. As a disc thins with aging and from daily wear and tear, the space between two spinal vertebrae shrinks. This causes the facet joints to press together.
脊柱的每個(gè)節(jié)段都有三個(gè)主要的活動(dòng)點(diǎn)，椎間盤(pán)以及兩側(cè)的關(guān)節(jié)突。任何一處的損傷會(huì)累及另外兩個(gè)位置。隨著年齡增長(zhǎng)，椎間盤(pán)變薄，以及日常的磨損、撕裂，兩個(gè)椎骨之間的間隙縮小。這會(huì)導(dǎo)致關(guān)節(jié)突關(guān)節(jié)的骨頭擠壓在一起。
Facet joints can also become arthritic due to a back injury earlier in life. Fractures, torn ligaments, and disc problems can all cause abnormal movement and alignment, putting extra stress on the surfaces of the facet joints.
早年的背部損傷也會(huì)促使關(guān)節(jié)突出現(xiàn)炎癥。骨折、韌帶撕裂以及椎間盤(pán)疾病都能引發(fā)異?；顒?dòng)以及脊柱排列異常，這會(huì)給予關(guān)節(jié)突表面額外的應(yīng)力。
The body responds to this extra pressure by developing bone spurs. As the spurs form around the edges of the facet joints, the joints become enlarged. This is called hypertrophy. Eventually, the joint surfaces become arthritic. When the articular cartilage degenerates, or wears away, the bone underneath is uncovered and rubs against bone. The joint becomes inflamed, swollen, and painful.
身體通過(guò)形成骨刺來(lái)對(duì)這些額外的應(yīng)力做出反應(yīng)。隨著骨刺在關(guān)節(jié)突周?chē)纬?，關(guān)節(jié)突增大，這就是所謂的關(guān)節(jié)肥大。最終，關(guān)節(jié)突表面出現(xiàn)炎癥。當(dāng)關(guān)節(jié)軟骨退變或者磨損，關(guān)節(jié)下骨就會(huì)暴露，骨與骨之間出現(xiàn)摩擦。整個(gè)關(guān)節(jié)突就會(huì)出現(xiàn)炎癥引發(fā)腫脹、疼痛。
View animation of facet arthritis
觀看關(guān)節(jié)突關(guān)節(jié)炎的動(dòng)畫(huà)
Facet joint arthritis develops slowly over a long period of time. This is partly because spinal degeneration in later life is the main cause of facet joint arthritis. Symptoms rarely develop immediately when degeneration is causing the problems. However, rapid movements, heavy twisting, or backward motions in the low back can injure a facet joint, leading to immediate symptoms.
關(guān)節(jié)突關(guān)節(jié)炎是在一個(gè)漫長(zhǎng)的時(shí)間里緩慢形成的。這一部分是因?yàn)槔夏昙怪嘶顷P(guān)節(jié)突關(guān)節(jié)炎的主要原因。當(dāng)退化引發(fā)關(guān)節(jié)炎，癥狀也很少馬上出現(xiàn)。然后下腰部的快速運(yùn)動(dòng)、大幅度扭轉(zhuǎn)或者背伸活動(dòng)會(huì)損傷關(guān)節(jié)突，導(dǎo)致即時(shí)的癥狀。
What does the condition feel like?
關(guān)節(jié)突關(guān)節(jié)炎的表現(xiàn)？
Pain from facet joint arthritis is usually worse after resting or sleeping. Also, bending the trunk sideways or backward usually produces pain on the same side as the arthritic facet joint. For example, if you lie on your stomach on a flat surface and raise your upper body, you hyperextend the spine. This increases pressure on the facet joints and can cause pain if there is facet joint arthritis.
關(guān)節(jié)突關(guān)節(jié)炎源性的疼痛通常在休息或睡眠時(shí)加重。此外，當(dāng)關(guān)節(jié)突有炎癥時(shí)，軀干側(cè)彎或者后伸會(huì)引起患側(cè)疼痛。例如，如果你在平板上俯臥，抬起你的上半身體，你的脊柱就處于過(guò)伸位。這會(huì)增加關(guān)節(jié)突的應(yīng)力，如果存在關(guān)節(jié)突關(guān)節(jié)炎，就會(huì)引發(fā)疼痛。
Pain may be felt in the center of the low back and can spread into one or both buttocks. Sometimes the pain spreads into the thighs, but it rarely goes below the knee. Numbness and tingling, the symptoms of nerve compression, are usually not felt because facet arthritis generally causes only mechanical pain. Mechanical pain comes from abnormal movement in the spine.
疼痛可能分布在腰部的中心，向一側(cè)或者雙側(cè)臀部放射。有時(shí)疼痛放射到大腿，但極少跨越膝蓋。通常沒(méi)有神經(jīng)壓迫癥狀——麻木和刺痛。這是因?yàn)殛P(guān)節(jié)突關(guān)節(jié)炎一般只引起機(jī)械性的疼痛。這源于脊柱異常的活動(dòng)。
However, symptoms of nerve compression can sometimes occur at the same time as the facet joint pain. The arthritis can cause bone spurs at the edges of the facet joint. These bone spurs may form in the opening where the nerve root leaves the spinal canal. This opening is called the neural foramen. If the bone spurs rub against the nerve root, the nerve can become inflamed and irritated. This nerve irritation can cause symptoms where the nerve travels. These symptoms may include numbness, tingling, slowed reflexes, and muscle weakness.
然而，神經(jīng)壓迫癥狀有時(shí)會(huì)與關(guān)節(jié)突疼痛同時(shí)發(fā)生。關(guān)節(jié)炎導(dǎo)致關(guān)節(jié)突邊緣的骨刺形成。這些骨刺可能位于神經(jīng)根離開(kāi)椎管的開(kāi)口處，也就是椎間孔。如果骨刺與神經(jīng)根發(fā)生摩擦，神經(jīng)會(huì)激惹發(fā)炎。神經(jīng)激惹會(huì)引發(fā)神經(jīng)支配區(qū)域的癥狀。這些癥狀包括麻木、刺痛、反射減弱以及肌肉無(wú)力。
How do doctors diagnose the problem?
醫(yī)生如何診斷該疾??？
Diagnosis begins with a complete history and physical examination. Your doctor will ask questions about your symptoms and how your problem is affecting your daily activities. This will include questions about where you feel pain and if you have numbness or weakness in your legs. Your doctor will also want to know what positions or activities make your symptoms worse or better.
診斷首先需要完整的病史采集以及體格檢查。醫(yī)生會(huì)詢(xún)問(wèn)你的癥狀以及病情對(duì)日常生活的影響。這包括疼痛部位，你的下肢是否有麻木或無(wú)力。醫(yī)生還會(huì)問(wèn)你哪些姿勢(shì)或活動(dòng)會(huì)使癥狀?lèi)夯蛘呔徑狻?/span>
Then the doctor performs a physical exam to determine which back movements cause pain or other symptoms. Your skin sensation, muscle strength, and reflexes are also tested.
隨后醫(yī)生會(huì)對(duì)你進(jìn)行體格檢查來(lái)明確哪些腰部活動(dòng)會(huì)引起疼痛或其他癥狀，并測(cè)試皮膚感覺(jué)、肌力以及反射。
X-rays can show if there are problems in the bone tissue in and near the facet joints. The images can show if degeneration has caused the space between the vertebrae to collapse and may show if bone spurs have developed near the facet joints.
X線能顯示關(guān)節(jié)突或者周?chē)墓墙M織是否有問(wèn)題。這些影像也能顯示是否有退變引起的椎間隙變窄以及是否有骨刺在關(guān)節(jié)突周?chē)纬伞?/span>
When more information is needed, your doctor may order magnetic resonance imaging (MRI). The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. This test gives a clear picture of the facet joints to see whether they are enlarged or swollen. This machine creates pictures that look like slices of the area your doctor is interested in. The test does not require dye or a needle.
當(dāng)需要更多信息時(shí)，醫(yī)生會(huì)要求你做磁共振，磁共振運(yùn)用磁場(chǎng)而不是X線來(lái)顯示機(jī)體軟組織，能清晰地顯示關(guān)節(jié)突的圖像以觀察是否有肥大或者腫脹，還能就醫(yī)生感興趣區(qū)域提供斷層圖像。它不需要造影及穿刺。
A computed tomography (CT) scan may be ordered. This is a detailed X-ray that lets your doctor see slices of bone tissue. The image can show whether the surface of the joint has eroded and whether bone spurs have developed.
醫(yī)生可能會(huì)要求你做CT掃描。通過(guò)計(jì)算機(jī)對(duì)X線圖像進(jìn)行處理，為醫(yī)生提供骨組織的斷層影像，能顯示關(guān)節(jié)表面是否有侵蝕或者是否有骨刺形成。
A diagnostic injection may be used to locate the source of pain. The doctor uses a long needle to inject a local anesthetic (numbing medication) into either the joint or into the nerve that goes to the joint. The doctor watches the needle on a fluoroscope to make sure it reaches the correct spot. A fluoroscope is a special X-ray television that allows the doctor to see your spine and the needle as it moves. Once the doctor is sure the needle is in the right place, the medicine and a special dye are injected. The doctor watches the dye to make sure the medication is correctly placed. The results from the injection help the doctor make the diagnosis. If pain goes away, it helps confirm the source of pain.
為明確疼痛來(lái)源，可采用一種診斷性注射方法。醫(yī)生用長(zhǎng)針在關(guān)節(jié)突或者支配神經(jīng)處注射局部麻醉藥。醫(yī)生會(huì)在透視下觀察針的位置以確保到達(dá)正確位置。透視是一種特殊的X線電視，能讓醫(yī)生在穿針時(shí)看到脊柱和針的位置。一旦醫(yī)生確定針已到達(dá)正確位置，就會(huì)注射藥物以及特殊的造影劑。醫(yī)生觀察造影劑來(lái)明確藥物注射在正確位置。注射后的結(jié)果有助于明確診斷。如果注射后疼痛消失，就能證實(shí)疼痛來(lái)源于關(guān)節(jié)突關(guān)節(jié)。
相關(guān)視頻：關(guān)節(jié)突關(guān)節(jié)注射（Facet Joint Injections）
What treatment options are available?
目前可選擇的治療方案有哪些？
Facet joint arthritis is mainly treated nonsurgically. At first, doctors may prescribe a short period of rest, one to two days, to calm inflammation and pain. Patients may find added relief by curling up to sleep on or by lying back with their knees bent and supported. These positions take pressure off the facet joints.
關(guān)節(jié)突關(guān)節(jié)炎主要非手術(shù)治療。首先，醫(yī)生會(huì)囑咐1~2天的短期休息，以緩解炎癥以及疼痛?；颊邥?huì)發(fā)現(xiàn)蜷曲睡覺(jué)或者膝關(guān)節(jié)屈曲墊起仰臥更能緩解不適，因?yàn)檫@些姿勢(shì)能消除關(guān)節(jié)突的應(yīng)力。
Your doctor may prescribe anti-inflammatory medication, such as a nonsteroidal anti-inflammatory drug (NSAID) or aspirin. Muscle relaxants are occasionally used to calm muscles that are in spasm. Oral steroid medicine in tapering dosages may also be prescribed for pain.
醫(yī)生會(huì)開(kāi)消炎藥，例如非甾體類(lèi)消炎藥物，阿司匹林。肌松藥視情況使用來(lái)緩解痙攣的肌肉。也會(huì)開(kāi)一些口服類(lèi)固醇藥物來(lái)緩解疼痛，但這些藥物需要逐漸減少劑量。
Patients often work with a physical therapist. By evaluating a patient’s condition, the therapist can assign positions and exercises to ease symptoms. The therapist may recommend traction. Traction is a common treatment for this condition. It gently stretches the low back and takes pressure off the facet joints. The therapist may also prescribe strengthening and aerobic exercises. Strengthening exercises focus on improving the strength and control of the back and abdominal muscles. Aerobic exercises are used to improve heart and lung health and increase endurance in the spinal muscles. Stationary biking offers a good aerobic treatment and keeps the spine bent slightly forward, a position that gives relief to many patients with lumbar facet joint arthritis.
患者經(jīng)?？梢宰鲎隼懑?。通過(guò)評(píng)估患者病情，理療師可以安排一些姿勢(shì)以及運(yùn)動(dòng)來(lái)緩解癥狀。理療師也會(huì)建議牽引治療。牽引是針對(duì)關(guān)節(jié)突關(guān)節(jié)炎的常用治療方法。它輕柔地牽拉下腰部來(lái)解除關(guān)節(jié)突的應(yīng)力。運(yùn)動(dòng)處方包括力量練習(xí)和有氧運(yùn)動(dòng)。力量練習(xí)主要提升腰背肌以及腹部肌肉的力量和控制。有氧運(yùn)動(dòng)則能改善心肺功能，提高脊柱肌肉的耐力。固定單車(chē)能提供一個(gè)良好的有氧運(yùn)動(dòng)治療方案，它使脊柱保持輕度前伸。這能緩解許多患者的腰椎關(guān)節(jié)突關(guān)節(jié)炎。
Patients who still have pain after trying various treatments may require injections into the facet joint or the small nerves that go to the joint. An anesthetic is used to block pain coming from the facet joint. The procedure to inject the medication into the joint is similar to the diagnostic injection described earlier. A steroid medication is occasionally used instead of the anesthetic. There is no strong evidence that these injections work. However, they seem to have some good short-term results with few side effects, so they shouldn’t be abandoned completely. Doctors often have their patients resume physical therapy treatments following an injection.
嘗試了各種各樣治療方法仍有疼痛的患者，可能需要進(jìn)行關(guān)節(jié)突關(guān)節(jié)注射或?qū)χ潢P(guān)節(jié)的小神經(jīng)進(jìn)行阻滯。麻醉藥物可阻斷來(lái)源于關(guān)節(jié)突關(guān)節(jié)的疼痛。在關(guān)節(jié)內(nèi)注射藥物的過(guò)程與前面所述的診斷性注射方法相似。常常用類(lèi)固醇類(lèi)藥物代替麻醉藥。沒(méi)有強(qiáng)有力的證據(jù)證明這些注射有效，然而，這些方法似乎有很好的短期療效，而且副作用很少，因此目前還沒(méi)完全被摒棄。注射后，醫(yī)生往往再次給病人做理療。
Related Document: A Patient’s Guide to Facet Joint Injections
相關(guān)閱讀：關(guān)節(jié)突注射的患者指南（翻譯招募中，有意者請(qǐng)留言）
腰椎背根內(nèi)側(cè)支神經(jīng)阻滯（Medial Branch Block）
People with facet joint arthritis rarely need surgery. However, facet joint arthritis is a primary source of chronic low back pain about 15 percent of the time. After trying other types of treatment, some of these patients may eventually require surgery. There are several types of surgery for facet joint arthritis. The two primary operations are
關(guān)節(jié)突關(guān)節(jié)炎患者很少需要外科干預(yù)。然而關(guān)節(jié)突關(guān)節(jié)炎是慢性下腰痛的主要來(lái)源，約占15%。在嘗試其他治療后，一些患者可能最終需要手術(shù)。對(duì)于關(guān)節(jié)突關(guān)節(jié)炎有一些外科方式。主要的兩種外科治療方式如下：
· facet rhizotomy
· 關(guān)節(jié)突神經(jīng)切斷術(shù)
· 后路腰椎融合
Facet Rhizotomy
關(guān)節(jié)突神經(jīng)切斷術(shù)
Rhizotomy describes a surgical procedure in which a nerve is purposely cut or destroyed. Facet rhizotomy involves severing one of the small nerves that goes to the facet joint. The intent of the procedure is to stop the transmission of pain impulses along this nerve. The nerve is identified using a diagnostic injection (described earlier). Then the surgeon inserts a large, hollow needle through the tissues in the low back. A special probe is inserted through the needle, and a fluoroscope is used to guide the probe toward the nerve. The probe is slowly heated until the nerve is severed.
關(guān)節(jié)突神經(jīng)切斷術(shù)講的是一種將神經(jīng)有意的切斷或破壞的手術(shù)方法。關(guān)節(jié)突神經(jīng)切斷術(shù)是切斷走行到關(guān)節(jié)突的神經(jīng)的一個(gè)分支。手術(shù)目的是終止神經(jīng)疼痛信號(hào)的傳遞。所需切斷的神經(jīng)通過(guò)診斷性神經(jīng)阻滯來(lái)確定（見(jiàn)前所述）。然后外科醫(yī)生在腰部組織內(nèi)插入一個(gè)粗而中空的針管，沿針管插入一個(gè)特定的探針，用透視輔助引導(dǎo)探針到達(dá)神經(jīng)部位，探針緩慢加熱直至神經(jīng)被離斷。
Posterior Lumbar Fusion
后路腰椎融合
Facet joint arthritis mainly causes mechanical pain, the type of pain caused by wear and tear in the parts of the lumbar spine. Posterior lumbar fusion for facet joint arthritis is mainly used to stop movement of the painful joints by joining two or more vertebrae into one solid bone (fusion). This keeps the bones and painful facet joints from moving.
關(guān)節(jié)突關(guān)節(jié)炎主要引起機(jī)械性疼痛，這是一種由于腰椎骨關(guān)節(jié)磨損撕裂引發(fā)的疼痛。治療關(guān)節(jié)突關(guān)節(jié)炎的后路腰椎融合術(shù)主要通過(guò)將兩個(gè)或者更多椎骨融合成一個(gè)骨塊來(lái)阻止病變處關(guān)節(jié)突的活動(dòng)。這阻止了椎骨以及引起疼痛的關(guān)節(jié)突關(guān)節(jié)的活動(dòng)。
In this procedure, the surgeon lays small grafts of bone over the back of the spine. Most surgeons will also apply metal plates and screws to prevent the two vertebrae from moving. This protects the graft so it can heal better and faster.
術(shù)中，外科醫(yī)生會(huì)將小的骨移植物放置在脊柱后方。大部分外科醫(yī)生也會(huì)應(yīng)用金屬板和螺釘固定來(lái)防止椎骨移位。這樣可以保護(hù)移植物更好更快地融合。
Related Document: A Patient’s Guide to Posterior Lumbar Fusion
相關(guān)閱讀：后路腰椎融合術(shù)患者指南（翻譯招募中，有意者請(qǐng)留言）
相關(guān)視頻：
后外側(cè)植骨術(shù)（Posterolateral Gutter Fusion Surgery）
后路腰椎椎體間融合術(shù)（Posterior Lumbar Interbody Fusion/PLIF）
非手術(shù)治療的康復(fù)
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 and chronic cases, patients may need a few additional weeks of care.
即使你不需要手術(shù)，醫(yī)生也會(huì)建議你進(jìn)行物理治療。正常情況下患者需要進(jìn)行為期4~6周，每周數(shù)次的物理治療。一些嚴(yán)重的慢性病例，患者需要額外增加治療周數(shù)。
Therapists create programs to help patients regain back movement, strength, endurance, and function. Treatments for facet joint arthritis often include lumbar traction, described earlier. Hands-on treatments such as massage and specialized forms of soft-tissue mobilization may be used initially. They are used to help patients begin moving with less pain and greater ease.
治療師設(shè)定治療計(jì)劃來(lái)幫助患者恢復(fù)背部活動(dòng)、力量、耐力以及功能。關(guān)節(jié)突關(guān)節(jié)炎的治療一般包括早期腰椎牽引（見(jiàn)前述）。起先會(huì)使用一些手法治療比如按摩以及特定形式的軟組織調(diào)理。這些有助于患者開(kāi)始活動(dòng)時(shí)疼痛更輕、更加容易。
Spinal manipulation can sometimes provide short-term relief of pain from facet arthritis. Commonly thought of as an adjustment, spinal manipulation stretches the tissues surrounding the facet joint and helps reset the sensitivity of the spinal nerves and muscles. It involves a high-impulse stretch of the spinal joints and is characterized by the sound of popping as the stretch is done. However, it doesn’t seem to provide effective long-term help when used routinely for chronic conditions.
脊柱推拿有時(shí)能短期緩解關(guān)節(jié)突炎性疼痛。脊柱推拿通常被認(rèn)為是種調(diào)節(jié)，能夠伸展關(guān)節(jié)突關(guān)節(jié)周?chē)慕M織，有助于重置脊神經(jīng)以及肌肉的敏感度。它包括高脈沖的牽拉脊柱關(guān)節(jié)，以牽拉時(shí)爆裂聲為特點(diǎn)。然而，當(dāng)常規(guī)用于慢性癥狀時(shí)，并不能帶來(lái)長(zhǎng)期的效果。
Patients are shown how to improve strength and coordination in the abdominal and low back muscles. Therapists can also evaluate their patients’ workstations or the way they use their bodies when they do their activities.
治療師會(huì)指導(dǎo)患者如何提高腰背以及腹部肌肉的力量和協(xié)調(diào)性。治療師也會(huì)評(píng)估患者的工作場(chǎng)所，或患者日常活動(dòng)時(shí)的方式。
Outpatient physical therapy is usually prescribed only for patients who have extra pain or show significant muscle weakness and deconditioning.
出院后物理治療通常僅限于格外疼痛或者明顯肌肉無(wú)力不協(xié)調(diào)的患者。
Patients usually don’t require physical therapy after facet rhizotomy. Surgeons may prescribe a short period of therapy when patients have lost muscle tone in their back and abdominal muscles, when they have problems controlling pain, or when they need guidance about returning to work.
患者一般在關(guān)節(jié)突神經(jīng)切斷術(shù)后不需要物理治療。當(dāng)患者背部或腹部肌肉張力低下，或者在緩解疼痛方面有問(wèn)題，或者需要關(guān)于恢復(fù)工作的指導(dǎo)，外科醫(yī)生可能會(huì)處方短期物理治療。
If patients require formal rehabilitation after facet rhizotomy, they will probably only need to attend sessions for two to four weeks. They should expect full recovery to take up to three months.
如果患者在關(guān)節(jié)突神經(jīng)切斷術(shù)后需要正規(guī)的康復(fù)治療，他們可能只需要參加2~4周的指導(dǎo)課程?；颊咄耆謴?fù)需要3個(gè)月。
Patients who have had lumbar fusion surgery normally need to wait at least six weeks before beginning a rehabilitation program. They typically need to attend therapy sessions for six to eight weeks and should expect full recovery to take up to six months.
腰椎融合術(shù)后或者正常需要至少六周休息，之后開(kāi)展康復(fù)。他們一般需要6~8周的康復(fù)治療，完全康復(fù)需要6個(gè)月。
During therapy after surgery, the therapist may use treatments such as heat or ice,electrical stimulation, massage, and ultrasound to help calm pain and muscle spasm. Then patients begin learning how to move safely with the least strain on the healing back.
在術(shù)后治療期間，治療師會(huì)使用熱療、冷療、電刺激、按摩以及超聲等療法來(lái)緩解疼痛以及肌肉痙攣。然后患者開(kāi)始學(xué)習(xí)如何使背部受力最小的情況下進(jìn)行安全活動(dòng)。
As the rehabilitation program evolves, patients do more challenging exercises. The goal is to safely advance strength and function.
隨著康復(fù)進(jìn)展，患者可以做更具挑戰(zhàn)性的鍛煉。目標(biāo)是安全的提升力量和功能。
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 need guidance on which activities are safe or how to change the way they go about their activities.
隨著治療到達(dá)尾聲，治療師會(huì)幫助患者回歸到他們熱愛(ài)的活動(dòng)，理想情況下，患者能恢復(fù)正常活動(dòng)。這時(shí)可以對(duì)他們進(jìn)行關(guān)于哪些活動(dòng)是安全的或者如何改變他們?nèi)粘；顒?dòng)方式的指導(dǎo)。
When treatment is well under way, regular visits to the therapist’s office will end. The therapist will continue to be a resource. But patients are in charge of doing their exercises as part of an ongoing home program.
當(dāng)治療進(jìn)展順利，就不用繼續(xù)定期找治療師就診。治療師仍然是一種資源。但患者出院后必須由自己繼續(xù)在家進(jìn)行康復(fù)鍛煉作為居家計(jì)劃的一部分。
翻譯：郭曉峰，南通大學(xué)2016級(jí)骨科碩士研究生，目前在南通大學(xué)第二附屬醫(yī)院參加規(guī)范化培訓(xùn)。
翻譯：郭曉峰，南通大學(xué)2016級(jí)骨科碩士研究生，目前在南通大學(xué)第二附屬醫(yī)院參加規(guī)范化培訓(xùn)。
校對(duì)：保國(guó)鋒
保國(guó)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(duì)象、南通市醫(yī)學(xué)重點(diǎn)人才、南通市“226高層次人才”培養(yǎng)對(duì)象。社會(huì)兼職：江蘇省醫(yī)學(xué)會(huì)骨科分會(huì)創(chuàng)傷學(xué)組委員、江蘇省中西醫(yī)結(jié)合學(xué)會(huì)骨科分會(huì)委員、北美脊柱外科學(xué)會(huì)(NASS)會(huì)員、南通市中西醫(yī)結(jié)合學(xué)會(huì)骨科分會(huì)委員。擅長(zhǎng)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(guó)OberlinHaus醫(yī)院、德國(guó)科隆大學(xué)醫(yī)院和韓國(guó)首爾國(guó)立大學(xué)醫(yī)院（SNUH）研修脊柱外科。
門(mén)診時(shí)間：周五全天
（編輯：胡佰文）
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