乳腺癌术后早期肩关节功能障碍风险评分系统的构建

Establishment of A Risk Scoring System for Early Stage Shoulder Joint Dysfunction after Breast Cancer Surgery

目的筛选与乳腺癌术后早期肩关节功能障碍发生有关的预测因素,并以此为基础构建乳腺癌术后早期肩关节功能障碍风险评分系统。方法采用回顾性病例对照研究,便利抽样选择2014年9月至2015年12月在浙江省中医院乳腺科住院并符合纳入标准的患者共110例,应用肩关节活动度(range of motion,ROM)测量金标准,将患者分为病例组(发生肩关节功能障碍)43例和对照组(未发生肩关节功能障碍)67例。收集患者的一般资料、治疗资料、心理及行为资料、社会资料,进行单因素Logistic回归分析和多因素logistic逐步回归(前进法)分析,根据回归分析纳入变量的回归系数和OR值分别建立预测乳腺癌术后早期肩关节功能障碍的Logistic评分系统和Additive评分系统。结果多因素逐步Logistic回归(前进法)分析结果显示,手术类型、家人是否监督、功能锻炼频率、功能锻炼时长、功能锻炼方式种类最终进入回归方程。Logistic评分系统和Additive评分系统分值分别为0~85分和3~22分,判定乳腺癌术后早期肩关节功能障碍高危人群的分值分别为≥52分和≥12.5分。结论乳腺癌术后早期肩关节功能障碍风险评分系统可以筛查乳腺癌术后早期肩关节功能障碍高危人群,为预防患者肩关节功能障碍提供指导和依据。

Objective To assess the influencing factors of early stage shoulder joint dysfunction after surgery in breast cancer patients,in order to establish a risk scoring system.Methods This was a retrospective case control study, with 110 cases were selected by using convenience sampling method.The patients were divided into experimental group（shoulder joint dysfunction,43 cases） and control group（non-shoulder joint dysfunction,67 cases） group,according to the shoulder joint range of motion（ROM） measurement standard.Single factor and multi-factor logistic regression analyses were performed on general characteristics, therapy information, psychological and behavioral data, and social information.According to regression coefficients and OR values for variables in the logistic regression equation,a logistic-and additive-scoring systems for predicting shoulder joint dysfunction in early stage after breast cancer surgery were established. Results Multiple-factor analysis indicated that surgery type, family supervision, and functional exercise frequency,time and pattern were the risk factors for early stage shoulder joint dysfunction after breast cancer surgery.Logistic and additive system scores were 0-85 and 3-22 ,respectively. Scores for the high risk group with early stage shoulder joint dysfunction after breast cancer surgery were≥52 and≥12.5,respectively.Conclusions The risk scoring system for early stage shoulder joint dysfunction after breast cancer surgery can screen the high risk group and also can provide a basis for prevention. ｜