Shoulder and Upper Extremities Function in Patients with Head and Neck Cancer after Selective Neck Dissection

頭頸癌患者於選擇性頸部廓清術後肩部及上肢的功能表現

謝函芩(Han-Chin Hsieh) ； 梁秋萍(Chau-Peng Leong) ； 李炎諭(Yan-Yuh Lee) ； 簡志彥(Chih-Yen Chien) ； 林佳璇(Chia-Hsuan Lin) ； 黃郁琦(Yu-Chi Huang)

《台灣復健醫學雜誌》 47卷2期 (2019/12) Pp. 99-107

https://doi.org/10.6315/TJPMR.201912_47(2).0003

摘要

Background: Shoulder dysfunction is common after nerve-sparing selective neck dissection (SND). We aimed to assess the upper extremity function and shoulder pain in patients with head and neck cancer (HNC) after SND. Methods: In this cross-sectional study, we enrolled 38 patients with HNCs after SND and evaluated shoulder active range of motion (ROM), muscle strength, pain, and the Disabilities of the Arm, Shoulder and Hand Score (DASH) questionnaire for upper extremity function on operative and non-operative sides. Results: Significant reductions in shoulder motions, muscle strength, and higher level of shoulder pain were observed on the operative side after SND. Worse upper extremity function was significantly associated with shoulder pain, and restricted shoulder ROM. DASH score is associated with shoulder flexion, extension and pain. Conclusion: Despite SND, there is still negative impact on upper extremity function, which is associated with decreased shoulder motions and shoulder pain. For setting practical rehabilitation in HNC patients with SND, the focus should be on regaining shoulder motions, especially shoulder flexion and extension, reducing shoulder pain, and getting better upper extremity performances.

關鍵字

head and neck cancer ； upper extremity ； selective neck dissection ； shoulder pain

並列摘要

目的：由於頸部廓清術後的患者常有肩部失能的狀況，本研究旨在評估頭頸癌患者於選擇性頸部廓清術後的上肢功能與肩部疼痛狀況。方法：本研究是一篇橫斷式研究，研究個案皆來自一間醫學中心接受選擇性頸部廓清術後的頭頸癌患者，研究中我們評估個案的肩關節主動關節活動度、肌肉力量、肩膀疼痛，並利用上肢功能問卷衡量患者的上肢功能，最後比較患者好側肩膀與患側肩膀的於上述功能之差異。結果：38位選擇性頸部廓清術後的頭頸癌患者的患側肩關節皆有明顯較差的關節活動度、肌肉力量、以及較高程度的肩部疼痛，相關性分析發現肩部疼痛與較差的上肢功能問卷分數有關，回歸分析顯示肩膀疼痛越劇烈、肩膀活動度越受限，上肢功能問卷分數越差，而肩關節屈曲、肩關節伸展與肩部疼痛為上肢功能問卷分數的預測因子。結論：儘管採取了選擇性頸部廓清術，頭頸癌患者的上肢功能仍在術後有負面影響，而且此影響與受限的關節活動度及肩膀疼痛有相關性；對於這類患者在制定復健計畫時，應特別注意對於肩部疼痛的積極介入，及恢復肩關節活動度，尤其是肩關節屈曲與肩關節伸展，如此才能使患者上肢功能達最佳表現。

並列關鍵字

頭頸癌（Head and neck cancer） ； 上肢（upper extremity） ； 選擇性頸部廓清術（selective neck dissection） ； 肩膀痛（shoulder pain）

參考文獻

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