頭頸部腫瘤手術後活動障礙之物理治療

Physiotherapy for Activity Impairments after Surgery for Head-Neck Cancer Patients

張瑞東(Rei-Tung Chang)

《腫瘤護理雜誌》 11卷2期 (2011/12) Pp. 1-10

https://doi.org/10.6880/TJON.201112_11(2).01

摘要

物理治療的介入能使頭頸部腫瘤患者在治療後所引發的各項功能障礙獲得改善，並能在最短的時間讓病人恢復最大活動功能及改善日常生活品質。頭頸部腫瘤病人不論接受手術切除、放射線或化學治療皆會產生不同程度的外貌及活動功能障礙，包括傷口容易感染、疼痛、出血、滲出物、惡臭等，患者日常生活的活動與獨立性常因而受限。適當物理治療是可以改善軟組織血液循環及血氧濃度、增加營養供應、促進傷口癒合，原則上每一動作重複10-15次／回，每天至少作3－5回，以和緩速度、漸進、不痛的程度為原則，建議手術後10－14天才開始物理治療。放射線治療或放射線合併化學治療結束後，應該儘快恢復主動及被動關節運動，以預防遲發性的軟組織纖維化。各項功能障礙治療方式有：（1）臉部浮腫：淋巴引流按摩、肌內效貼紮。（2）肩頸酸麻、活動度受限制：拉筋運動、頭頸部主動運動、運動球、拉胸大肌。（3）張口困難：鬆動顳顎關節、定點式疤痕按摩（涵蓋所有疤痕組織）、協助性關節運動、肩頸拉筋、使用壓舌板輔助。上述各項治療方法及關節運動，有助於傷口組織癒合並讓纖維化組織增加彈性及柔軟度，進而可改善活動功能。

關鍵字

頭頸部腫瘤 ； 傷口照護 ； 物理治療

並列摘要

Physiotherapy is intervened to improve the functional impairments caused by treatments in head-neck cancer patients. The intervention can help recover the patient's utmost functions in a short time, and improve their quality of life. Treatments of head-neck cancer patients such as surgery, radiation, and chemical therapy all can incur different impairments on appearance and activity functions. Patients' wounds are vulnerable to infection, pain, bleeding, effusion, and odor. The impairments restrict the patients’ daily activities and independency. The appropriate physiotherapy can improve the circulation and oxygen saturation, enhance the supply of nutrition, and facilitate the wound healing and cell activation. The principles of the exercise are to move slowly step by step, without pain, three to five rounds each day, and ten to fifteen times each round. It is recommended that the beginning time for physiotherapy should be about ten to fourteen days after surgery, and perform passive/active joint exercise as soon as possible after radiation or radiochemical treatment to prevent from deferred soft tissue fibrosis. Treatments for different impairments include: (A) Facial edema: lymph drainage and massage and use Kinesio tape; (B) Sour/numb shoulder and neck, and restricted activity: a stretching exercise, active exercise on head/ neck, sports ball, and pectoral major muscle extension; (C) Hard to open mouth: temporomandibular joint release, fixed spot scar massage (including all scar tissues), assistive joint exercise, and shoulder/neck extension e.g. spatula use. The above actions can stimulate the wound recovery, increase flexibility and softness of tissue fibrosis to avoid muscle rigidity, and to improve activity function of extremities.

並列關鍵字

head-neck cancer ； wound care ； physiotherapy