锁骨上皮瓣修复头颈部缺损术后肩功能评估

Evaluation of shoulder function after repairing head and neck defects with supraclavicular flap

目的评估锁骨上皮瓣修复头颈部缺损术后患者的肩功能变化。方法回顾性分析2013年1月至2020年12月首都医科大学附属北京同仁医院耳鼻咽喉头颈外科应用锁骨上皮瓣修复头颈部缺损56例患者的临床资料,其中男性54例,女性2例,年龄35~74岁,记录皮瓣面积、分型、供区切口是否裂开和感染等近期并发症情况。并应用快速上肢功能障碍简式评分表(quick disabilities of the arm,shoulder and hand,Quick-DASH)对符合纳入肩部、上肢临床功能评价标准的43例患者进行评价,对比锁骨型和肩峰型皮瓣患者术后上肢功能障碍情况,并选取43例中同期行双侧颈部淋巴清扫的患者30例,供区(观察组)和对侧(对照组)进行双侧对比评价。使用SPSS 22.0统计学软件处理数据。结果获取锁骨上皮瓣面积(4~10)cm×(10~18)cm,3例(5%)患者供区缺损宽度为8~10 cm,无法直接拉拢缝合,制取局部皮瓣修复肩部缺损,其他病例均直接缝合;3例(5%)患者术后肩峰区切口裂开,局部换药2周后愈合。随访时间为6~43(27±14)个月,所有患者均无外形不满意。43例患者中锁骨型28例(65%),肩峰型15例(35%);肩峰型运动能力值、Quick-DASH值均高于锁骨型[(14.4±4.7)分比(11.8±3.1)分,t=2.105,P=0.048;(16.9±11.6)分比(12.2±7.1)分,t=2.284,P=0.033]。30例同期行双侧颈部淋巴清扫的患者,观察组运动能力值、局部症状值及Quick-DASH值均高于对侧对照组[运动能力值:(13.4±5.8)分比(9.8±4.2)分,t=3.024,P=0.004;局部症状值:(4.1±1.0)分比(3.4±1.0)分,t=2.537,P=0.014;Quick-DASH值:(15.6±14.7)分比(5.2±11.1)分,t=3.106,P=0.003]。结论锁骨上皮瓣术后存在肩功能障碍,且与皮瓣分型相关。

Objective To evaluate the shoulder function in patients after repair of head and neck defects with supraclavicular flap.Methods A retrospective analysis was performed on 56 patients(54 males,2 females,aged 35-74 years old)who received the repair of head and neck defects with supraclavicular flaps at Department of Otorhinolaryngology Head and Neck Surgery of Beijing Tongren Hospital,Capital Medical University in January 2013-December 2020.The areas and types of flaps,disruption or infections of the incision at the donor sites and other postoperative complications were recorded.Quick disabilities of the arm,shoulder and hand(Quick-DASH)was used for evaluating the shoulder functions in 43 patients conforming to the standard for evaluation of the clinical functions of shoulders and upper limbs,to compare the postoperative upper limb functions between patients treated with clavicular flaps and patients with acromion flaps.Meanwhile,30 patients who received bilateral neck lymph node dissection over the same period of time were selected for a comparative evaluation of the donor sides(observation group)and the opposite sides(control group).Data were processed with SPSS 22.0.Results The areas of obtained supraclavicular flaps were(4-10)cm×(10-18)cm.Three patients(5%)showed the defect widths of 8-10 cm at the donor sites,which couldn′t be sutured directly,received the repair of their shoulder defects with partial flaps.Defects in other patients were sutured directly.After surgery,3 patients(5%)suffered from disruption of the acromion incision,which healed after 2 weeks of local dressing.The follow-up time was 6-43(27±14)months.All patients expressed no dissatisfaction with the appearance.Among 43 patients,28(65%)were clavicular type and 15(35%)were acromion type.The acromion type showed average motor ability and Quick-DASH scores higher than the clavicular type[(average motor ability:(14.4±4.7)vs.(11.8±3.1),t=2.105,P=0.048;Quick-DASH:(16.9±11.6)vs.(12.2±7.1),t=2.284,P=0.033].Among 30 patients who received bilateral neck lymph node dissection over the same period of time,the observation group showed higher average motor ability,local symptoms and Quick-DASH scores than the control group[average motor ability:(13.4±5.8)vs.(9.8±4.2),t=3.024,P=0.004;average local symptoms:(4.1±1.0)vs.(3.4±1.0),t=2.537,P=0.014;Quick-DASH:(15.6±14.7)vs.(5.2±11.1),t=3.106,P=0.003].Conclusion Shoulder dysfunction exists after treatment with supraclavicular flap,which is related to the flap type.