自编颞颌关节运动操对鼻咽癌患者放疗后张口困难的影响

Influence of Self-designed Temporomandibular Joint Gymnastics on Trismus in Nasopharyngeal Carcinoma Patients after Radiotherapy

目的探讨颞颌关节运动操对鼻咽癌患者放疗后张口困难的预防效果。方法将200例初治鼻咽癌放疗患者,按入院顺序随机分成观察组和对照组各100例,观察组从放疗即日起在主管护士的指导下,进行颞颌关节运动操功能锻炼,放疗结束出院后继续自行锻炼;对照组进行常规的放疗健康教育,按传统张口运动法进行锻炼。在放疗前、放疗结束和放疗后1年、2年分别对两组患者的门齿距进行测量和比较。结果 (1)放疗1年时,观察组98例发生张口困难Ⅰ级12例,Ⅱ级4例,Ⅲ～Ⅳ级0例,共16例(16%);对照组97例发生张口困难Ⅰ级30例,Ⅱ级4例,Ⅲ级0例,Ⅳ级1例,共35例(36%),经比较,两组差异有统计学意义(P<0.05)。(2)放疗2年时,观察组发生张口困难Ⅰ级16例,Ⅱ级4例,Ⅲ～Ⅳ级0例,共20例(20%);对照组发生张口困难Ⅰ级25例,Ⅱ级14例,Ⅲ级1例,Ⅳ级1例,共41例(42%),经比较,两组差异有统计学意义(P<0.05)。结论坚持做颞颌关节运动操功能锻炼,能有效降低鼻咽癌患者放疗后张口困难的发生率及严重程度。

Objective To explore the effect of temporomandibular joint gymnastics on trismus in nasopharyngeal carcinoma patients after radiotherapy.Methods Newly-diagnosed patients were randomly divided into experiment group（n=100） and control group（n=100）.Patients in experiment group received functional training with temporomandibular joint gymnastics under the direction of nurses-in-charge while patients in control group received routine health education and carried on functional training with traditional methods.The distances between upper and lower incisor of patients were measured at the beginning of radiotherapy,the end of radiotherapy,1 year and 2 years after radiotherapy,respectively.Results In experiment group,16 patients（16%） developed trismus 1 year after radiotherapy and 20 patients（20%） 2 years later.In control group,35 patients（36%） developed trismus 1 year after radiotherapy and 41 patients（42%） 2 years later.The differences between two groups were statistically significant（P0.05）.Conclusion Temporomandibular joint gymnastics can effectively lower the incidence of trismus and mitigate the severity of trismus after radiotherapy in patients with nasopharyngeal carcinoma.