Department of Oral and Maxillofacial Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan.
Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan.
Medicine (Baltimore). 2022 Oct 21;101(42):e30910. doi: 10.1097/MD.0000000000030910.
There are clinical and statistical inconsistencies regarding early intervention with manual lymphatic drainage (MLD). The purpose of this study was to compare the short-term effect of early interventions with rehabilitation exercise versus MLD and rehabilitation exercise in terms of pain, range of motion (ROM) and lymphedema in patients with oral cancer after surgery.
A total of 39 patients who underwent surgery from December 2014 to December 2018 participated in this randomized single-blind study. There were 20 patients in the rehabilitation (R) group and 19 in the MLD (M) plus rehabilitation group. The R group received 30 minutes of rehabilitation intervention; and the M group received 30 minutes of MLD, in addition to 30 minutes of rehabilitation intervention in a work day. Clinical measures, including the visual analog pain scale (VAS), ROM of the neck and shoulder, ultrasonography and face distance for lymphedema, and the Földi and Miller lymphedema scales, were assessed before surgery, before intervention and when discharged from the hospital.
The VAS pain score, ROM of the neck, and internal and external rotation of the right shoulder were significantly improved after the interventions. Right-face distance (P = .005), and skin-to-bone distance (SBD) of the bilateral horizontal mandible and left ascending mandibular ramus were significantly improved after the interventions. Left lateral flexion of the neck (P = .038) and SBD of the right ascending mandibular ramus (P < .001) in the MLD group showed more improvement than that of the rehabilitation group.
Early intervention with MLD and the rehabilitation program were effective in improving ROM of the neck and controlling lymphedema in acute-phase rehabilitation. The preliminary findings suggest a potential therapeutic role for early intervention with MLD, in addition to rehabilitation exercise, in that they yielded more benefits in lymphedema control and improvement of ROM of the neck in acute care.
关于早期行手动淋巴引流（MLD）干预的临床和统计学结果存在不一致。本研究旨在比较早期康复运动与 MLD 联合康复运动在口腔癌术后患者疼痛、活动度（ROM）和淋巴水肿方面的短期疗效。
2014 年 12 月至 2018 年 12 月，共 39 例接受手术的患者参与了这项随机单盲研究。其中 20 例为康复组（R 组），19 例为 MLD 联合康复组（M 组）。R 组接受 30 分钟康复干预，M 组除了在工作日接受 30 分钟 MLD 外，还接受 30 分钟康复干预。在术前、干预前和出院时评估临床指标，包括视觉模拟疼痛量表（VAS）、颈部和肩部 ROM、超声和面部距离评估淋巴水肿，以及 Földi 和 Miller 淋巴水肿量表。
干预后 VAS 疼痛评分、颈部 ROM 和右肩内、外旋均显著改善。干预后右侧面部距离（P=0.005）和双侧水平下颌骨及左侧升支下颌骨的皮肤与骨骼距离（SBD）明显改善。与康复组相比，MLD 组的左侧颈部侧屈（P=0.038）和右侧升支下颌骨 SBD（P<0.001）的改善更为显著。
早期行 MLD 联合康复方案可有效改善颈部 ROM 并控制急性康复期的淋巴水肿。初步研究结果表明，早期行 MLD 干预联合康复运动可能具有治疗作用，在控制淋巴水肿和改善颈部 ROM 方面的获益更为显著。
