细节化物理治疗应用于甲状腺癌围手术期康复临床效果研究

Effectiveness of detailed physiotherapy in perioperative rehabilitation of thyroid cancer

目的 探讨细节化物理治疗对甲状腺癌颈淋巴结清扫术后患者康复效果的影响。方法 纳入2021年2月-6月于四川大学华西医院接受手术治疗的甲状腺恶性肿瘤患者97例,随机分为试验组50例和对照组47例。试验组患者接受细节化物理治疗,对照组患者接受常规围手术期康复。比较两组患者术后4周内手术区域疼痛程度、手术相关颈肩部不舒适程度以及术后第4周颈淋巴结清扫损伤指数。疼痛评分非正态分布,数据以中位数(下四分位数,上四分位数)表示,采用广义估计方程比较组间差异;不舒适程度评分和颈淋巴结清扫损伤指数呈正态分布,数据以均数±标准差表示,前者采用多元方差分析比较组间差异,后者采用t检验比较组间差异。结果 术后第1、2、3、4周,试验组手术区域疼痛程度评分分别为2.2(1.7,3.3)、1.5(1.0,2.2)、1.5(0.0,2.3)、0.0(0.0,1.2)分,对照组分别为3.4(2.7,5.2)、2.6(1.5,3.5)、2.4(1.1,3.4)、1.5(1.1,2.0)分;试验组手术相关颈肩部不舒适程度评分分别为(8.72±4.14)、(5.28±2.98)、(5.89±2.78)、(3.57±1.83)分,对照组分别为(10.56±5.30)、(7.54±4.51)、(7.37±3.49)、(5.05±2.59)分。术后4周内,试验组手术区域疼痛程度评分和手术相关颈肩部不舒适程度评分均低于对照组,差异有统计学意义(Waldχ^(2)=28.826,P<0.001;F=7.695,P=0.007)。术后第4周,试验组颈淋巴结清扫损伤指数高于对照组,差异有统计学意义[(75.23±20.40) vs.(63.83±19.52)分;t=2.809,P=0.006]。结论 细节化物理治疗对甲状腺癌颈淋巴结清扫术后患者康复效果优于常规围手术期康复治疗。

Objective To explore the effectiveness of detailed physiotherapy in perioperative rehabilitation of patients undergoing thyroid cancer surgery with lymph node dissection.Methods A total of 97 patients with thyroid malignancy who underwent surgical treatment in West China Hospital of Sichuan University between February and June2021 were selected and randomly divided into the trial group(n=50) and the control group(n=47).The patients in the trial group received detailed physiotherapy,and the patients in the control group received routine perioperative rehabilitation.The degree of pain within the operation area and the degree of neck and shoulder discomfort associated with surgery within 4 weeks,and the scores of Neck Dissection Impairment Index 4 weeks after surgery were compared between the two groups.The pain score,which was non-normally distributed,was described by median(lower quartile,upper quartile) and compared by generalized estimation equation;the discomfort score and score of Neck Dissection Impairment Index,which were normally distributed,were described by mean ± standard deviation,and the former was compared by multivariate analysis of variance,and the latter was compared by Student’s t-test.Results In the 1st,2nd,3rd,and 4th week after surgery,the pain scores within the operation area were 2.2(1.7,3.3),1.5(1.0,2.2),1.5(0.0,2.3),and 0.0(0.0,1.2),respectively in the trial group,and 3.4(2.7,5.2),2.6(1.5,3.5),2.4(1.1,3.4),and 1.5(1.1,2.0),respectively in the control group;the surgery-related neck and shoulder discomfort scores were 8.72±4.14,5.28±2.98,5.89±2.78,and3.57±1.83,respectively in the trial group,and 10.56±5.30,7.54±4.51,7.37±3.49,and 5.05±2.59,respectively in the control group.Within 4 weeks after operation,the surgical-area pain scores and surgery-related neck and shoulder discomfort scores in the trial group were lower than those in the control group,and the differences were statistically significant(Waldχ~2=28.826,P<0.001;F=7.695,P=0.007).In the post-operative week 4,the Neck Dissection Impairment Index in the trial group was higher than that in the control group,and the difference was statistically significant(75.23±20.40 vs.63.83±19.52;t=2.809,P=0.006).Conclusion For patients undergoing thyroid cancer surgery with lymph node dissection,detailed physiotherapy intervention is more effective than routine perioperative rehabilitation.