Mozzini Carolina Barreto, Rodrigues Telma Ribeiro, Bergmann Anke, Roussenq Suellen Cristina, Kowalski Luis Paulo, Carvalho André Lopes
Postgraduate Program - University of Sao Paulo Medical School, São Paulo, Brazil.
Physiotherapist/CEO at Santátil, Passo Fundo, Brazil.
Int J Health Sci (Qassim). 2022 Jul-Aug;16(4):22-29.
Accessory nerve (AN) manipulation or resection during neck dissection (ND) generates accessory nerve shoulder dysfunction (ANSD). The aim of the present study was to assess adherence to a supervised physiotherapy protocol and subsequent changes in the functionality scores of patients with ASND with accessory nerve (AN) preservation.
This study consisted of an uncontrolled clinical trial was carried out at the Department of Head and Neck Surgery and Otorhinolaryngology at the A.C. Camargo Cancer Center, comprising progressive isotonic and isometric strengthening of scapular stabilizer muscles. In patients with head-and-neck cancer underwent ND with AN preservation and patients with ANSD. Shoulder range of motion (ROM), middle trapezius, lower trapezius, rhomboid and anterior serratus muscle strength, pain, and quality of life (QoL) were measured in the pre-operative and 1 and 3 post-operative months. There were included patients over 18 years old, with head-and-neck cancer who underwent ND with AN preservation and patients with ANSD.
A total of 55 patients were evaluated, with a mean age of 53 (±13.23). Significant improvement in the functionality scores of almost all variables between pre- and post- physiotherapy was observed. Most patients (70.9%) adhered and completed the protocol, obtaining significantly greater ROM abduction ( = 0.009) and lower trapezius strength ( = 0.011) than partially performing patients.
When performed completely, the proposed physiotherapy protocol can minimize loss in muscle movements and strength, especially limited after ND. The results indicate that the proposed protocol is safe and has the potential to reduce ANSD.
颈部清扫术（ND）期间对副神经（AN）进行操作或切除会导致副神经肩部功能障碍（ANSD）。本研究的目的是评估对一项有监督的物理治疗方案的依从性，以及保留副神经（AN）的ANSD患者功能评分的后续变化。
本研究为一项非对照临床试验，在A.C.卡马戈癌症中心头颈外科和耳鼻喉科进行，包括对肩胛稳定肌进行渐进性等张和等长强化训练。纳入接受保留AN的ND的头颈癌患者以及患有ANSD的患者。在术前、术后1个月和3个月测量肩部活动范围（ROM）、中斜方肌、下斜方肌、菱形肌和前锯肌力量、疼痛及生活质量（QoL）。纳入年龄超过18岁、接受保留AN的ND的头颈癌患者以及患有ANSD的患者。
共评估了55例患者，平均年龄为53岁（±13.23）。观察到物理治疗前后几乎所有变量的功能评分均有显著改善。大多数患者（70.9%）依从并完成了方案，与部分执行方案的患者相比，外展ROM（P = 0.009）和下斜方肌力量（P = 0.011）显著更大。
当完全执行时，所提议的物理治疗方案可将肌肉运动和力量的损失降至最低，尤其是在ND后受限的情况。结果表明，所提议的方案是安全的，并且有可能减少ANSD。
