Trunk Function in Rectus Abdominis Myocutaneous Flap Patients

腹直肌移轉乳房重建手術患者之軀幹功能

徐阿田(Ar-Tyan Hsu) ； John Lorant ； Lucinda Baker ； Deana Brodke ； Jennifer Johnson ； Flora Woo

《中華民國物理治療學會雜誌》 21卷1期 (1996/01) Pp. 20-32

https://doi.org/10.29616/JPTAROC.199601.0003

摘要

腹直肌移轉乳房重建手術(TRAM)是取用對側腹直肌及其覆蓋的皮膚與皮下組織作為重建乳房的素材。本研究的目的是評估此類病患軀幹功能自然恢復的過程，以作為決定是否給予此類病患早期物理治療的依據。作者共收集了18個病例，其中有12個病例完成了手術前與手術後6個月的評估。有8位元患者完成實驗的全程。作者發現此類病患的軀幹活動度於伸直與向患側側彎的方向有明顯的減少。軀幹向非患側側彎的肌力與角速度亦有顯著的減少。據此結果，作者建議對此類病患除了給予一般對乳房摘除病人的治療手續外，還應加上軀幹的姿態、活動度與重力訓練，以預防因手術喪失一側腹直肌所造成的問題。

關鍵字

腹直肌移轉乳房重建手術 ； 軀幹功能

並列摘要

The transverse rectus abdominis musculocutaneous (TRAM) flap procedure involves transfer of abdominal tissue to the contralateral chest wall, and then shaped into a breast. This procedure involves sacrifice of one or both sides the rectus abdominis muscles. The purpose of this preliminary study was to investigate the course of recovery of trunk functions in TRAM patients who did not receive any physical therapy intervention. A dynamometer was used to measure strength and ROM of the trunk in three cardinal planes. A total of eighteen patients participated. Twelve patients completed the first two tests and eight completed all three tests consisting of a pre, a 6- month and a 12-month postsurgical tests. The results showed significant decreases (p＜0.05) in (1) ROM in extension and lateral bending to the operated side, (2) angular velocity of lateral bending to the non-operated side, (3) isometric trunk strength of lateral bending to the non-operated side. Trunk flexion strength did show 27.5% and 12.5% reduction at 6-month and 12-month postsurgery comparing to presurgery. The reductions in extension strength during the same time points were 14% and 11% respectively. Both, however, were not statistically significant. The deficits found in this study indicate a need for early physical therapy intervention for the TRAM patients to prevent loss of trunk strength and ROM. The authors suggest that scar tissue mobilization, trunk mobility and strengthening exercises should be added to traditional physical therapy programs for mastectomy patients with TRAM breast reconstructive surgery. A much longer follow- up period is necessary to gauge the full extent the persistent residual loss (or imbalance) of trunk function and potential deformity as a result of the TRAM surgery.

並列關鍵字

Transverse rectus abdominis musculocutaneous flap ； Trunk function