英汉对照骨科患者指南019：腰椎间盘突出（上）

Lumbar Disc Herniation

腰椎间盘突出

A Patient’s Guide to Lumbar Disc Herniation

腰椎间盘突出患者指南

Introduction

简介

Although people often refer to a as a slipped disc, the disc doesn’t actually slip out of place. Rather, the term herniation means that the material at the center of the disc has squeezed out of its normal space. This condition mainly affects people between 30 and 40 years old.

虽然普通人都认为“椎间盘突出”是椎间盘从椎间隙中滑出，但是事实上并非如此，“突出”指的是椎间盘中心处的物质因某些原因被“挤”出了正常位置。这一疾病好发于30~40岁的人群。

This guide will help you understand

这一指南可以帮助你了解

· how the problem develops

· 这一疾病如何发生发展？

· how doctors diagnose the condition

· 医生如何诊断这一疾病？

· what treatment options are available

· 患者可以选择什么治疗手段？

Anatomy

解剖

What parts of the spine are involved?

脊柱的哪一部分受累及？

The human spine is formed by 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to form the spinal column. The spinal column gives the body its form. It is the body’s main upright support. The section of the spine in the lower back is known as the lumbar spine.

人体脊柱由24根脊椎骨组成，这些脊椎骨被称为“椎骨”。椎骨相互间上下堆叠形成脊柱。脊柱赋予身体外形，是人体直立主要的支撑力。脊柱的腰段部分即称为腰椎。

The lumbar spine is made up of the lower five vertebrae. Doctors often refer to these vertebrae as L1 to L5. These five vertebrae line up to give the low back a slight inward curve. The lowest vertebra of the lumbar spine, L5, connects to the top of the sacrum, a triangular bone at the base of the spine that fits between the two pelvic bones. Some people have an extra, or sixth, lumbar vertebra. This condition doesn’t usually cause any particular problems.

腰椎是由下端的5个椎骨组成的，医生通常以腰1至腰5来命名它们。这五个椎骨依次排列使腰部具有一个轻微的向前的弧度。腰椎的最后一个椎骨L5与骶骨相连。骶骨是脊柱底部一块三角形的骨头，位于两侧髋骨的中间。有些人有另一额外的第六腰椎骨，这通常不会引起特别的毛病。

Intervertebral discs separate the vertebrae. The discs are 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. These fibers help the disc withstand tension and pressure.

相邻的椎骨由椎间盘分开。椎间盘由结缔组织形成。结缔组织将细胞牢牢地结合在一起。大多数的结缔组织由胶原纤维形成，帮助椎间盘承受张力和压力。

A disc is made of two parts. The center, called the nucleus, is spongy. It provides most of the disc’s ability to absorb shock. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it. Ligaments are connective tissues that attach bones to other bones.

椎间盘由两部分组成。中央部又被称为髓核，是一种海绵状的松软组织。它能够吸收大部分作用于椎间盘的外力振动。髓核由一圈坚强的韧带环包绕，称为纤维环。韧带是连接骨与骨的结缔组织。

Healthy discs work like shock absorbers to cushion the spine. They protect the spine against the daily pull of gravity. They also protect it during strenuous activities that put strong force on the spine, such as jumping, running, and lifting.

健康的椎间盘作为脊柱的震荡缓冲垫，抵抗日常的重力的牵拉。同时也能保护脊椎在剧烈活动对脊柱造成强烈的牵拉时免于受伤，比如跳跃，跑步，举重物等。

Related Document:

相关阅读：腰椎退行性疾病患者指南

英汉对照骨科患者指南009：腰椎间盘退变性疾病

英汉对照骨科患者指南009：腰椎间盘退变性疾病（下）

Vigorous, repetitive bending, twisting, and lifting can place abnormal pressure on the shock-absorbing nucleus of the disc. If great enough, this increased pressure can injure the annulus, leading to herniation.

剧烈地，反复地弯腰，扭腰以及提重物可以对椎间盘的髓核产生异常的压力。若这压力足够大可以对纤维环造成损伤，引起椎间盘突出。

A lumbar disc can also become herniated during an acute (sudden) injury. Lifting with the trunk bent forward and twisted can cause a disc herniation. A disc can also herniate from a heavy impact on the spine, such as falling from a ladder and landing in a sitting position.

腰椎间盘也可在急性受伤中突出。在举重物时向前弯腰或扭腰可以导致腰椎间盘突出。同时施加于脊椎的冲击力也可以导致腰椎间盘突出，例如从梯子上跌落并坐到地面。

Herniation causes pain from a variety of sources. It can cause mechanical pain. This is pain that comes from the parts of the spine that move during activity, such as the discs and ligaments. Pain from inflammation occurs when the nucleus squeezes through the annulus. The nucleus normally does not come in contact with the body’s blood supply. However, a tear in the annulus puts the nucleus at risk for contacting this blood supply. When the nucleus herniates into the torn annulus, the nucleus and blood supply meet, causing a reaction of the chemicals inside the nucleus. This produces inflammation and pain. A disc herniation may also put pressure against a spinal nerve. Pressure on an irritated or damaged nerve can produce pain that radiates along the nerve. This is called neurogenic pain.

椎间盘突出可造成许多不同原因的疼痛。机械性疼痛来源于在运动中有活动的脊椎成分，例如椎间盘和韧带。炎症性疼痛发生于髓核从纤维环中突出。髓核通常不与身体血供直接接触，然而纤维环的撕裂使其有暴露于血液的风险。当髓核从被撕裂的纤维环中突出时，髓核与血液相遇，导致髓核内的化学物质产生反应，产生炎症和疼痛。椎间盘突出同样可能对脊神经造成挤压。对受激或被破坏的神经产生压力可以产生这根神经的放射痛，这种疼痛被称神经源性痛。

Symptoms

症状

What does the condition feel like?

腰椎间盘突出会有什么症状？

Many cases of lumbar disc herniation result from degenerative changes in the spine. The changes that eventually lead to a disc herniation produce symptoms gradually. At first, complaints may only be dull pain centered in the low back, pain that comes and goes over a period of a few years. Doctors think this is mainly from small tears in the annulus. Larger cracks in the annulus may spread pain into the buttocks or lower limbs.

许多腰椎间盘突出的病例都由脊柱的退行性变引起。症状都是逐渐发展的。首先，主要症状为集中于腰部的钝痛，可以在几年中反复出现。医生认为这种疼痛主要是由于纤维环的轻微撕裂引起的。纤维环的大范围撕裂导致的疼痛可蔓延至臀部与下肢。

When the disc herniates completely through the annulus, it generally causes immediate symptoms, with sharp pain that starts in one and shoots down part or all of the leg. Commonly, patients no longer feel their usual back pain, only leg pain. This is likely because painful tension on the annulus releases when the nucleus pushes completely through.

当髓核完全穿透纤维环时，一般造成以从一侧臀部向下放射至整条腿的锐痛。此时患者只有腿痛而没有以往常见的背痛。这种现象可能是由髓核穿透纤维环释放张力引起的。

Disc herniations produce inflammation when the nucleus comes in contact with the body’s blood supply (mentioned earlier). The inflammation can be a source of throbbing pain in the low back and may spread into one or both hips and buttocks.

上文提到过，当髓核与肌体血供接触时可导致炎症，从而导致腰部的搏动性疼痛。这一疼痛可蔓延至一侧或两侧髋部与臀部。

A herniated disc can press against a spinal nerve, producing symptoms of nerve compression. Nerve pain follows known patterns in the lower limbs. It can be felt on the side of the upper thigh, in the calf, or even in the and toes.

突出的椎间盘可以压迫脊神经，产生神经压迫症状。下肢的神经痛具有固定的模式。一般蔓延至大腿上部，小腿甚至在足部和脚趾。

Pressure on the nerve can also cause sensations of pins, needles, and numbness where the nerve travels down the lower limbs. If this happens, a person’s reflexes slow. The muscles controlled by the nerve weaken, and sensation in the skin where the nerve goes is impaired.

神经的挤压也可以在神经的下肢分配区引起针刺感以及麻木感。此时，病人的反射减慢。神经支配的肌肉肌力减弱，神经感觉支配区感觉功能受损。

Rarely, symptoms involve changes in bowel and bladder function. A large disc herniation that pushes straight back into the spinal canal can put pressure on the nerves that go to the bowels and bladder.

椎间盘突出偶尔会影响肠道和膀胱功能。较大的椎间盘直接向后推挤椎管，对支配肠道和肠道的神经施加压力。

The pressure may cause , pain running down the back of both legs, and numbness or tingling between the legs in the area you would contact if you were seated on a saddle. The pressure on the nerves can cause a loss of control in the bowels or bladder. This is an emergency. If the pressure isn’t relieved, it can lead to permanent paralysis of the bowels and bladder. This condition is called cauda equina syndrome. Doctors recommend immediate surgery to remove pressure from the nerves.

这种压力可以造成腰痛，放射至双腿后侧，以及鞍区（两腿之间的区域，当坐于马鞍上会接触到的部位）麻木或针刺感。施加于神经的压力会导致对肠道和膀胱失去控制。这是紧急情况。若压力持续不缓解，最终可导致肠道和膀胱的永久性瘫痪，这一情况被称为马尾综合征。此时医生推荐紧急手术解除神经压迫。

Diagnosis

诊断

How do doctors diagnose the problem?

医生们如何诊断这一疾病？

Diagnosis begins with a complete history and physical exam. Your doctor will ask questions about your symptoms and how your problem is affecting your daily activities. These will include questions about where you feel pain and whether 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. Doctors rely on your report of pain to get an idea which disc is causing problems and if a nerve is being squeezed.

诊断通常从完整的病史和体格检查开始。医生会询问患者症状以及这些症状对日常生活的影响。这些问题包括疼痛的部位，以及双腿是否有麻木或乏力感。医生同时也会询问使症状缓解或加重的姿势与活动。通过患者对于疼痛的描述医生可以推断出患病的椎间盘并且判断是否有神经被挤压。

Then the doctor examines you to determine which back movements cause pain or other symptoms. Your skin sensation, muscle strength, and reflexes are also tested.

医生随后将进行体格检查，判断哪些背部运动会引起疼痛以及其他症状。同时也检查患者的皮肤感觉，肌力和反射。

X-rays are of minor help in diagnosing disc herniations. The discs don’t actually show up on X-rays. However, doctors can tell if the space between the vertebrae is smaller than normal. This can be an indication that wear and tear on one or more discs is causing problems. However, many peoples’ X-rays show degeneration of the discs. This is because degeneration in the discs is part of aging, like skin that wrinkles with time.

由于椎间盘不能在X光片上显示，因此X光片几乎不能帮助医生诊断腰椎间盘突出。但医生可以从X光片上看出椎间隙相较于正常变窄，这一现象可以提示一个或多个椎间盘的劳损与撕裂。然而许多病人的X光片可以展示椎间盘的退变，这是由于椎间盘的退化也是属于老化的一部分，就如随着时间出现的皮肤皱纹一样。

Computed tomography (a CT scan) may be ordered. This is a detailed X-ray that lets doctors see slices of the body’s tissue. The image can show if a herniated disc is putting pressure on a spinal nerve.

患者可以进行CT检查。CT与X光相比更为细致，能够显示身体组织的切面。CT图像可以显示突出的椎间盘是否压迫到了脊神经。

Doctors may combine the CT scan with myelography. To do this, a special dye is injected into the space around the spinal canal, called the the subarachnoid space. When the CT scan is performed, the dye highlights the spinal cord and nerves. The dye can improve the accuracy of a standard CT scan for diagnosing a herniated disc.

有时医生会结合CT检查与脊髓造影。在这一过程中，操作者往患者在椎管周围被称为蛛网膜下腔的部位中注入造影剂。在进行CT扫描时，造影剂可使脊髓和神经突出显影。造影剂可以提高标准CT诊断突出椎间盘的精确性。

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. It gives a clear picture of the discs and whether a herniation is present. Like the CT scan, this machine creates pictures that look like slices of the area your doctor is interested in. The test does not require special dye or a needle.

当医生需要了解更多信息时，可能会要求病人进行磁共振检查。磁共振机器使用磁力波而不是X光显示机体的软组织。它可以清楚的显示椎间盘以及是否有椎间盘突出。磁共振和CT一样展现的是身体特定部位的横切面，这一检查并不需要特别的造影剂或针穿刺。

Doctors sometimes order a specialized X-ray test called discography. In this test, dye is injected into one or more discs. The dye is seen on X-ray and can give some information about the health of one or more discs. This test may be used when surgery is being considered to determine which disc is causing problems.

医生们有时会要求患者进行一项特殊的检查，称为椎间盘造影。在1个或多个椎间盘中注入染料，在X光中即可显示椎间盘，从而判断椎间盘是否正常。在考虑手术时，一般可用这一检查确定病变的椎间盘。

Doctors may also order electrical tests to locate more precisely which spinal nerve is being squeezed. Several tests are available to see how well the nerves are functioning, including the electromyography (EMG) test. This test measures how long it takes a muscle to work once a nerve signals it to move. The time it takes will be slower if a herniated disc has put pressure on a spinal nerve. Another test is the somatosensory evoked potential (SSEP) test. The SSEP is used to measure nerve sensations. These sensory impulses travel up the nerve, informing the body about sensations such as pain, temperature, and touch. The function of a nerve is recorded by an electrode placed over the skin in the area where the nerve travels. Doctors will often run these tests before performing surgery for a lumbar disc herniation.

患者也可能需要进行电生理检查以准确定位被压迫的脊神经。有许多检查可以检测神经的功能是否良好，肌电图是其中之一。肌电图对肌肉从神经发出指令到产生运动的时间间隔进行测量。当突出的椎间盘对神经产生压迫时这一时间会延长。另一检查称为躯体感觉诱发电位测试，用于测量神经感觉功能。感觉冲动沿神经向上传递，使机体感觉到痛觉，温度觉，触觉。这一过程通过粘贴于神经对应的皮肤上的电极记录。医生在对患者进行腰椎间盘突出手术前一般都会进行这些检查。

（洪澜译胡佰文校）

洪澜，女，浙江大学医学院临床医学专业学生，已被复旦大学录取为神经内科研究生。

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