不同干预措施对头颈癌病人术后颈肩功能障碍影响的网状Meta分析

Interventions on neck and shoulder function dysfunction of postoperative patients with head and neck cancer:a network Meta-analysis

目的:采用网状Meta分析方法评价7种不同干预措施对头颈癌病人术后颈肩功能障碍的影响。方法:计算机检索PubMed、the Cochrane Library、Web of Science、EMbase、中国生物医学文献数据库、维普数据库、中国知网、万方数据库中关于不同干预措施对头颈癌病人术后颈肩功能影响的随机对照试验,检索时限为建库至2024年5月23日。由2名研究者独立进行文献筛选、资料提取。采用RevMan 5.4对纳入的文献进行偏倚风险质量评价,采用ADDIS 1.16.8及Stata 15.0进行网状Meta分析及图形绘制。结果:共纳入19项研究,涉及1386例病人、7种干预措施。网状Meta分析结果显示,针灸在改善肩关节功能评价指标[SMD=49.97,95%CI(42.77,57.28),P<0.05]和颈淋巴结损伤指数[SMD=19.16,95%CI(1.84,36.35),P<0.05]方面疗效较好;颈肩有氧操在改善颈部侧屈[SMD=9.61,95%CI(5.73,12.88),P<0.05]及颈部旋转[SMD=12.82,95%CI(5.54,34.31),P<0.05]方面疗效较好。结论:当前证据显示,针灸是降低头颈癌病人术后肩部疼痛、提高其日常生活能力最优先推荐的干预措施;颈肩有氧操在提高病人颈部运动度(颈部侧屈、颈部旋转)方面具有优势,但还需更多高质量的研究进一步验证此结论。

Objective:To evaluate the effects of seven different interventions on neck and shoulder function dysfunction of postoperative patients with head and neck cancer using network Meta-analysis.Methods:A computerized search of randomized controlled trials on the effects of different interventions on neck and shoulder function and daily living ability of postoperative patients with head and neck cancer was performed in PubMed,the Cochrane Library,Web of Science,EMbase,CBM,VIP,CNKI and WanFang Database.The retrieval time was from the inception to May 23,2024.Literature screening and data extraction were performed independently by two researchers.RevMan 5.4 was used to evaluate the quality of the included literature for risk of bias,and ADDIS 1.16.8 and Stata 15.0 were used for network Meta-analysis and graphing.Results:A total of 19 studies with 1386 patients involving 7 interventions were included.The results of the network Meta-analysis showed that acupuncture had the better efficacy in improving functional evaluation indexes of the shoulder joint(SMD=49.97,95%CI 42.77-57.28,P<0.05)and NDII(SMD=19.16,95%CI 1.84-36.35,P<0.05);and neck and shoulder aerobics had the best efficacy in improving lateral neck flexion(SMD=9.61,95%CI 5.73-12.88,P<0.05),and neck rotation(SMD=12.82,95%CI 5.54-34.31,P<0.05).Conclusion:Current evidence suggests that acupuncture is the most preferred recommended intervention to reduce postoperative shoulder pain and improve the ability of daily living in patients with head and neck cancer;and neck and shoulder aerobics are advantageous in improving neck mobility(neck lateral flexion,and neck rotation),but more high-quality studies are needed to further validate this conclusion.