阶段式康复训练法改善颈部淋巴清扫术后患者肩综合征的效果评价

Evaluation of the effectiveness of a phased rehabilitation training programme to relieve shoulder dysfunction in patients after neck dissection

目的探讨阶段式康复训练改善颈部淋巴清扫术后患者肩综合征的效果,为患者术后肩关节功能恢复提供有效方案。方法本研究已通过单位伦理委员会审查批准,并获得患者知情同意。制定颈部淋巴清扫术后肩部阶段式康复训练计划,选取中山大学附属口腔医院2020年12月至2021年4月符合纳入标准的患者70例,随机分成试验组和对照组(每组各35例)。对照组进行常规护术后护理,主要包括术后6周开始进行肩关节活动训练、协调性训练和颈部小范围活动训练等运动康复训练至术后12个月;试验组则在常规术后护理的基础上,增加术前、术后全麻清醒至拆线、拆线至术后6周、术后6周至12个月4个阶段渐进性开展术前熟悉手法训练、术后保护性康复训练、运动型康复训练、抗阻训练等阶段式康复训练计划。两组受试者训练频率均为至少3次/周,每次训练时长为10~15 min,锻炼强度为Borg自觉运动强度分级2~3分(即轻到中度的呼吸急促或疲劳),并分别在术前、术后3个月、术后6个月、术后12个月使用淋巴清扫损伤指数(neck dissection impairment index,NDII)评估其肩关节功能相关生活质量,分数越高表示生活质量越高。结果试验组28例和对照组32例完成了1年的随访。在术后3、6个月,试验组受试者的NDII显著高于对照组[术后3个月:试验组(93.48±9.36)vs.对照组(80.00±11.34)(P<0.001),术后6个月:试验组(98.21±4.76)vs.对照组(90.70±9.12)(P<0.001)];术后12个月,试验组受试者的NDII(97.23±4.88)仍高于对照组(96.33±4.49),但是差异无统计学意义(P=0.458)。两组受试者在术后3、6、12个月3个时间点的组内NDII得分比较,差异均具有统计学意义(P<0.001)。结论阶段式康复训练法在颈部淋巴清扫术患者中应用具有可行性,有助于加速患者术后6个月内肩关节功能及生活质量的恢复。

Objective To explore the effect of a phased rehabilitation training programme to relieve shoulder dys-function in patients after neck dissection and to provide effective solutions for postoperative shoulder joint function recov-ery of patients.Methods This study has been reviewed and approved by the Ethics Committee,and informed consent has been obtained from patients.A phased rehabilitaiton training programme for the shoulder after neck dessection was developed through literature review and discussion,and 70 eligible patients from Hospital of Stomatology,Sun Yat-sen University from December 2020 to April 2021 were selected and randomly divided into the test group and control group(35 patients in each group).The control group underwent motor rehabilitation training from 6 weeks postoperative to 1 year after surgery,such as shoulder mobility and coordination training and small range of motion training of the neck,while the test group took part in a rehabilitation training program that included familiarization maneuver training,protective rehabilitation,exercise rehabilitation,and resistance training in the following four stages:preoperative,postop-erative general anesthesia and awake until the removal of stitches,the removal of stitches until 6 weeks after surgery,and 6 weeks after surgery until 1 year after surgery.The frequency of training in both groups was at least 3 days per week,and the length of each training session was 10-15 min.The intensity of exercise was 2-3 points on the Borg Conscious Ex-ercise Intensity Scale(i.e.,mild-to-moderate tachypnea or fatigue).The neck dissection injury index(NDII)was used to evaluate the quality of life related to shoulder joint function at four time points:preoperative,postoperative 3 months,postoperative 6 months,and postoperative 12 months.The higher the score,the better the quality of life.Results 28 cases in the test group and 32 cases in the control group completed a one-year follow-up.At 3 and 6 months postopera-tive,the NDII of the test group was significantly higher than that of the control group[3 months postoperative:test group(93.48±9.36)vs.control group(80.00±11.34)(P<0.001),6 months postoperative:test group(98.21±4.76)vs.control group(90.70±9.12)(P<0.001)];12 months after surgery,the NDII of the test group(97.23±4.88)was still higher than that of the control group(96.33±4.49),but the difference was not statistically significant(P=0.458).The difference in NDII scores among subjects at 3,6,and 12 months after surgery was statistically significant in each group(P<0.001).Conclusion The application of the phased rehabilitation training method in neck dissection patients has a feasibility and could improve the quality of life of patients'shoulder joint function within 6 months after surgery.