腰椎峽部裂
腰椎峽部裂患者指南
治療
What treatment options are available?
有哪些治療方案可供選擇？
非手術(shù)治療
Doctors often begin by prescribing nonsurgical treatment for spondylolysis. This is because symptoms from these stress fractures often resolve with rest or bracing. In some cases, doctors simply monitor their patients’ condition to see if symptoms improve. An X-ray may be taken every few months to check how well the area is healing.
醫(yī)生通常首先選擇非手術(shù)方法來治療峽部裂。這是因?yàn)檫@些應(yīng)力性骨折引起的癥狀通常可以通過休息和腰圍來解決。對于有些病人，醫(yī)生只是簡單的觀察患者的情況，看看癥狀是否改善。可能每隔數(shù)月行X線檢查了解局部是否愈合。
If the doctor feels that the problem is due to a recent fracture, you may be placed in a rigid back brace or cast for three to four months. Keeping the spine from moving can help ease pain and inflammation. It can also improve the chances the bones will grow back together. Most people who require a brace or cast overcome symptoms and are able to eventually get back to activities free of pain. This can happen even when follow-up tests show that the bones haven’t completely healed.
如果醫(yī)生認(rèn)為這個病是由于新近的骨折造成的，會要求你用一個硬性腰圍或支具固定3～4個月。避免脊柱活動有助于減輕疼痛和炎癥，并提高骨頭長回到一起的機(jī)會。大多數(shù)需要腰圍或支具來消除癥狀和疼痛的病人，最終能夠恢復(fù)無痛的活動，即使后續(xù)隨訪檢查發(fā)現(xiàn)骨頭沒有完全愈合。
Your doctor may ask that you rest your back by limiting your activities. The purpose of this is to help decrease inflammation and calm muscle spasm. You may need to take some time away from your sport, especially if it requires repeated back bending. This gives your back a chance to heal. Most patients who follow these measures get better. Patients are rarely counseled to completely discontinue participating in their sport, and only in severe cases.
你的醫(yī)生可能會讓你限制活動以使腰部得到休息。其目的是有助于減少炎癥和減輕肌肉痙攣。你可能需要在一段時間內(nèi)避免運(yùn)動，尤其是需要反復(fù)向后彎腰的運(yùn)動，給你的腰一個愈合的機(jī)會。大多數(shù)遵循這些措施的患者會逐漸好轉(zhuǎn)?；颊吆苌俦唤ㄗh完全停止參加運(yùn)動，除非情況很嚴(yán)重。
Patients often work with a physical therapist. After evaluating your condition, a therapist can assign positions and exercises to ease your symptoms. The therapist may design an exercise program to improve the strength and control of your back and abdominal muscles. By watching you perform your sport activity, your therapist can suggest style, technique, or equipment changes to improve your performance and prevent future problems.
患者通常需要物理治療師一起治療。評估你的病情后，治療師會指導(dǎo)姿勢和鍛煉從而來緩解你的癥狀。治療師可能會設(shè)計一個鍛煉方案來改善你的背部和腹部肌肉的力量和控制。通過觀察你體育活動的表現(xiàn)，治療師會建議你改變運(yùn)動的形式、技術(shù)或設(shè)備來提高你的水平和防止未來的問題。
手術(shù)
Most patients with spondylolysis do not require surgery. When symptoms are not relieved with nonsurgical treatments, however, patients may require surgery. The main types of surgery for spondylolysis include
大多數(shù)峽部裂患者不需要手術(shù)。當(dāng)非手術(shù)治療不能緩解癥狀時，病人可能需要通過手術(shù)治療。峽部裂主要手術(shù)方式包括：
椎板切除術(shù)
Nerve compression can cause considerable pain and symptoms. If too much cartilage builds up where the fractured bones are trying to heal, the nerve that passes near the injured bone may get squeezed, as described earlier. To fix this, a section of the bony ring is removed to take pressure off the nerve. The procedure to remove the lamina from the bony ring and release pressure on the nerve is called laminectomy.
神經(jīng)壓迫會引起相當(dāng)?shù)奶弁春桶Y狀。如果當(dāng)骨折部位試圖愈合時長出太多的軟骨，經(jīng)過傷骨附近的神經(jīng)可能會被擠壓，如前所述。為了解決這個問題，切除部分的椎板來減輕神經(jīng)壓迫。將椎板從骨環(huán)上切除并解除神經(jīng)上的壓迫的手術(shù)稱為椎板切除術(shù)。
Related Document: A Patient’s Guide to Lumbar Laminectomy
相關(guān)閱讀:腰椎椎板切除術(shù)患者指南（翻譯招募中，有意者留言）
Posterior Lumbar Fusion
后路腰椎融合術(shù)
A spinal fusion may be required after a surgeon performs a laminectomy procedure. Fusion is recommended when a spinal segment (a set of vertebrae) has become too loose or unstable.
外科醫(yī)生進(jìn)行椎板切除成形術(shù)后可能需要做脊柱融合術(shù)。當(dāng)一個脊柱節(jié)段(一組椎骨)已變得過于松動或不穩(wěn)定，推薦進(jìn)行融合術(shù)。
脊柱融合術(shù)允許兩個或兩個以上的骨頭長在一起，或融合成一個堅固的骨頭。這樣可阻止骨和關(guān)節(jié)運(yùn)動。術(shù)中，外科醫(yī)生將少量移植骨放到脊柱背側(cè)的病變區(qū)域。一些外科醫(yī)生也使用金屬板和螺釘防止兩個椎骨移動。然而，這種做法是有爭議的，因?yàn)榇蠹s90%峽部裂兒童沒有使用鋼板和螺釘而發(fā)生了融合。
Related Document: A Patient’s Guide to Posterior Lumbar Fusion
康復(fù)
What should I expect as I recover?
我恢復(fù)好預(yù)期能達(dá)到什么樣的狀況？
非手術(shù)治療的康復(fù)
Recovery from this condition is much like nonsurgical treatment mentioned earlier. Once you have rested your back to allow it to heal, your doctor may recommend that you work with a physical therapist a few times each week for four to six weeks. In severe cases, patients may need a few additional weeks of physical therapy.
這種情況的恢復(fù)，就像前面提到的非手術(shù)治療。一旦你為了你愈合而休息腰椎，你的醫(yī)生可能會建議你跟物理治療治一起合作，每周幾次進(jìn)行四到六周。在嚴(yán)重的情況下,病人可能需要增加幾數(shù)來進(jìn)行物理治療。
The first goal of treatment is to control symptoms. The therapist works with you to find positions and movements that ease pain. Treatments of heat, cold, ultrasound, and electrical stimulation may be used to calm pain and muscle spasm.
治療的首要目標(biāo)是控制癥狀。治療師會同你一起訓(xùn)練去發(fā)現(xiàn)某種體位和運(yùn)動能減輕疼痛?？捎脽?、冷、超聲波和電刺激等治療來減輕疼痛和肌肉痙攣。
As you recover, you will gradually advance in 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.
隨著你的恢復(fù)，你將逐漸增加的一系列的腹部和背部肌肉的強(qiáng)化訓(xùn)練。鍛煉這些核心肌肉能幫助病人更容易活動并降低了未來發(fā)生疼痛和其它問題的機(jī)會。
When needed, a therapist can work closely with a sports coach on strategies for a patient’s safe return to his or her sport. The two may provide suggestions on technique, equipment, and training frequency and intensity.
如有需要，治療師可以與一個體育教練密切合作，共同商議策略讓一個病人安全的回到他或她的運(yùn)動中去。兩者可以提供技術(shù)上、設(shè)備上、訓(xùn)練的頻率和強(qiáng)度上的建議。
如果病人是一個有工作的成人，治療師也可以與病人的醫(yī)生和雇主合作，來幫助病人盡快恢復(fù)工作。病人可能需要先做輕的工作。一旦病人有能力，他（或她）就可以做正常的工作活動。治療師也可以建議病人作出改變，以幫助病人安全地工作，降低他（或她）的腰部再受傷的機(jī)會 。
A primary purpose of therapy is to help patients learn how to take care of their symptoms and prevent future problems. Patients are given a home program of exercises to continue improving flexibility, posture, endurance, and low back and abdominal strength. The therapist also describes strategies you can use if your symptoms flare up.
治療的主要目的是幫助患者學(xué)習(xí)如何處理他們的癥狀和預(yù)防未來的問題。提供給患者家庭訓(xùn)練計劃來提高靈活性、姿勢、耐力、腰和腹部的力量。如果你的癥狀突然加重或復(fù)發(fā)，治療師也會有相應(yīng)的策略讓你使用。
Most adolescents get better after wearing a brace or cast for three months. Even then, a CT scan sometimes shows an unhealed fracture. In these cases, however, symptoms often go away completely, allowing a safe return to sports. Patients do best when guided in a gradual manner with the supervision of a therapist and sports coach.
通過三個月的腰圍或支具固定大多數(shù)青少年恢復(fù)良好，甚至有時CT掃描顯示骨折并未愈合。在這些情況下，通常癥狀完全消失，允許安全返回運(yùn)動。治療師和體育教練以漸進(jìn)的方式監(jiān)督引導(dǎo)訓(xùn)練時，病人恢復(fù)最好。
術(shù)后康復(fù)
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(shù)后康復(fù)更復(fù)雜。有些病人手術(shù)后不久就離開醫(yī)院。然而，一些手術(shù)要求病人在醫(yī)院呆幾天。住院病人術(shù)后在病房可以請醫(yī)院的物理治療師來治療，治療和幫助患者在沒有額外的腰部受力下活動和日常運(yùn)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.
在手術(shù)后的康復(fù)期間，患者應(yīng)該遵循他們的外科醫(yī)生的指示穿戴支具或腰圍以支撐后背。在手術(shù)后的最初幾周他們應(yīng)小心運(yùn)動過度。
Many surgical patients need physical therapy outside of the hospital. Patients who’ve had lumbar fusion surgery normally need to wait at least six weeks before beginning a rehabilitation program. This delay gives the fusion a chance to start healing. Patients typically need to attend therapy sessions for six to eight weeks and should expect full recovery to take up to six months.
許多手術(shù)患者需要在院外進(jìn)行物理治療，那些行腰椎融合手術(shù)的病人通常需要等六個星期以后才能進(jìn)行康復(fù)訓(xùn)練。這種延遲康復(fù)提供了融合節(jié)段愈合的機(jī)會?；颊咄ǔＰ枰獏⒓恿桨酥艿目祻?fù)治療，完全康復(fù)則需要六個月。
（李治 譯 胡佰文 校對）
李治，男，吉林大學(xué)在讀博士。<中國組織工程研究>>雜志審稿專家，遼寧省細(xì)胞生物學(xué)會分子生物學(xué)專業(yè)主任委員，遼寧省細(xì)胞生物學(xué)會干細(xì)胞與再生專業(yè)副主任委員，遼寧省細(xì)胞生物學(xué)會骨創(chuàng)傷委員會常務(wù)副主任委員，遼寧省中西醫(yī)結(jié)合委員會骨創(chuàng)傷專業(yè)委員，中國國際AO脊柱委員會會員，中國國際AO創(chuàng)傷委員會會員。
主要研究方向：頸、腰椎退變手術(shù)治療，脊柱脊髓損傷脊髓梳理等手術(shù)治療，細(xì)胞生物治療脊髓損傷。擅長復(fù)雜骨盆骨折開放及微創(chuàng)手術(shù)。積極開展脊髓損傷的科研與臨床轉(zhuǎn)化。
E-mail：lz8534@163.com
通訊地址：遼寧省沈陽市鐵西區(qū)南七西路五號 沈陽醫(yī)學(xué)院附屬中心醫(yī)院骨外四科
患者指南，圖文并茂，
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