以實證執業運用於鼻咽癌療癒者肩關節功能障礙的物理治療：病例報告

Evidence Based Practice in Physical Therapy for Nasopharyngeal Cancer Survivor with Shoulder Dysfunction: A Case Report

黃卉君(Hui-Chun Huang) ； 林慧芬(Heui-Fen Lin)

《物理治療》 37卷3期 (2012/09) Pp. 271-276

摘要

鼻咽癌居台灣男性癌症第十名，鼻咽癌治療以放射及化學治療為主，若有頸部淋巴轉移會以手術做頸部淋巴廓清術。鼻咽癌治療衍生後遺症包括疼痛、組織纖維化與僵硬、張口困難、進食與語言障礙、以及肩關節功能障礙等，對於患者身體功能與生活品質造成很大影響。本報告個案為一位55歲的男性鼻咽癌患者接受手術、放射與化學治療後，因頸部疼痛與肩關節障礙轉介物理治療，經物理治療評估後，診斷本個案肩頸疼痛與肩關節活動障礙可能來自於手術後發生脊副神經麻痺，導致肩胛動作失調所致。物理治療介入包括肩部肌肉的阻力訓練、靜態姿勢與動態肩部協調動作訓練，以降低肩部肌力不平衡的不良影響及疼痛、增加肌力與改善肩功能障礙。經過五個多月物理治療，個案在疼痛有明顯改善，但斜方肌依舊無力。肩關節障礙在頭頸部癌患者相當常見，作者針對其癌症治療所引起的肩關節障礙，從文獻資料了解造成肩關節障礙的原因與衍生問題，並探討物理治療師如何評估、物理治療介入原則及療效做整理與報告。相關文獻對於頭頸部腫瘤患者肩關節障礙之物理治療介入原則、時機與效果，目前仍欠缺一致建議與充足證據支持，有待進一步研究。

關鍵字

頭頸部癌症 ； 物理治療 ； 阻力運動訓練

並列摘要

Nasopharyngeal cancer (NPC) ranks the 10th major male cancer in Taiwan. Most of NPC patients are treated by radiation therapy, which may be combined with chemotherapy. Neck dissection is performed in case of cervical metastasis. Physical sequelae following cancer treatments, such as pain, fibrosis and stiffness, trismus, dysphagia, speech difficulty and shoulder dysfunction, have negative impacts on physical function and quality of life. A case of 55-year-old male of NPC survivor was referred to physical therapy (PT) for his neck pain and shoulder dysfunction. According to PT evaluation, scapular dyskinesia secondary to accessory neuropathy, which may be a sequela after cervical dissection, was noted. PT program included resistance training for shoulder muscles, postural correction and dynamic scapular control training. The pain was subsided after PT for 5 months. But trapezius paralysis persisted. Shoulder dysfunction after oncological treatment was common in head and neck cancer patients. We reviewed the causes, diagnosis, PT intervention and effectiveness of such shoulder dysfunction, and found that more research are needed to identify the type and timing of PT that may be benefit.

並列關鍵字

Head and neck cancer ； Physical therapy ； Resistance training