Gane Elise M, O'Leary Shaun P, Hatton Anna L, Panizza Benedict J, McPhail Steven M
1 School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
2 Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Australia.
Otolaryngol Head Neck Surg. 2017 Oct;157(4):631-640. doi: 10.1177/0194599817721164. Epub 2017 Jul 25.
Objective To measure patient-perceived upper limb and neck function following neck dissection and to investigate potential associations between clinical factors, symptoms, and function. Study Design Cross-sectional. Setting Two tertiary hospitals in Brisbane, Australia. Subjects and Methods Inclusion criteria: patients treated with neck dissection (2009-2014).
aged <18 years, accessory nerve or sternocleidomastoid sacrifice, previous neck dissection, preexisting shoulder/neck injury, and inability to provide informed consent (cognition, insufficient English). Primary outcomes were self-reported function of the upper limb (Quick Disabilities of the Arm, Shoulder, and Hand) and neck (Neck Disability Index). Secondary outcomes included demographics, oncological management, self-efficacy, and pain. Generalized linear models were prepared to examine relationships between explanatory variables and self-reported function. Results Eighty-nine participants (male n = 63, 71%; median age, 62 years; median 3 years since surgery) reported mild upper limb and neck dysfunction (median [quartile 1, quartile 3] scores of 11 [3, 32] and 12 [4, 28], respectively). Significant associations were found between worse upper limb function and longer time since surgery (coefficient, 1.76; 95% confidence interval [CI], 0.01-3.51), having disease within the thyroid (17.40; 2.37-32.44), postoperative radiation therapy (vs surgery only) (13.90; 6.67-21.14), and shoulder pain (0.65; 0.44-0.85). Worse neck function was associated with metastatic cervical lymph nodes (coefficient, 6.61; 95% CI, 1.14-12.08), shoulder pain (0.19; 0.04-0.34), neck pain (0.34; 0.21-0.47), and symptoms of neuropathic pain (0.61; 0.25-0.98). Conclusion Patients can experience upper limb and neck dysfunction following nerve-preserving neck dissection. The upper quadrant as a whole should be considered when assessing rehabilitation priorities after neck dissection.
目的 测量颈部清扫术后患者自我感知的上肢和颈部功能，并研究临床因素、症状和功能之间的潜在关联。研究设计 横断面研究。研究地点 澳大利亚布里斯班的两家三级医院。研究对象与方法 纳入标准：2009 - 2014年接受颈部清扫术的患者。
年龄<18岁、副神经或胸锁乳突肌被切除、既往有颈部清扫术、既往有肩部/颈部损伤以及无法提供知情同意（认知、英语水平不足）。主要结局指标为上肢（手臂、肩部和手部快速残疾评定量表）和颈部（颈部残疾指数）的自我报告功能。次要结局指标包括人口统计学特征、肿瘤治疗、自我效能感和疼痛。采用广义线性模型来检验解释变量与自我报告功能之间的关系。结果 89名参与者（男性n = 63，71%；中位年龄62岁；术后中位时间3年）报告有轻度上肢和颈部功能障碍（上肢和颈部的中位[四分位数1，四分位数3]得分分别为11[3，32]和12[4，28]）。发现上肢功能较差与术后时间较长（系数1.76；95%置信区间[CI]，0.01 - 3.51）、甲状腺内有疾病（17.40；2.37 - 32.44）、术后放疗（与仅手术相比）（13.90；6.67 - 21.14）以及肩部疼痛（0.65；0.44 - 0.85）之间存在显著关联。颈部功能较差与颈部转移性淋巴结（系数6.61；95%CI，1.14 - 12.08）、肩部疼痛（0.19；0.04 - 0.34）、颈部疼痛（0.34；0.21 - 0.4）以及神经性疼痛症状（0.61；0.25 - 0.98）有关。结论 保留神经的颈部清扫术后患者可能会出现上肢和颈部功能障碍。在评估颈部清扫术后的康复优先级时，应将整个上象限考虑在内。
