Anehosur Venkatesh, Vadera Hitesh, Bhat Adithi, Satyanarayana S, Kumar Niranjan
SDM Craniofacial Surgery and Research Centre, SDM College of Dental Science and Hospital, Shri Dharmasthala Manjunatheshwar University, Dharwad, Karnataka India.
Department of Oral and Maxillofacial Surgery, AMC Dental College Khokhara, Ahmedabad, India.
Indian J Otolaryngol Head Neck Surg. 2022 Oct;74(Suppl 2):2582-2588. doi: 10.1007/s12070-020-02279-w. Epub 2020 Nov 18.
The aim was to compare the morbidity of shoulder function following modified radical neck dissection with and without Pectoralis Major Myocutaneous muscle flap (PMMC) harvest in head and neck cancer patient to determine the effect of PMMC flap harvest on shoulder function and also to determine the effect of physiotherapy. Materials and methods: Prospective study involving two groups study group of 20 patients with MRND, with PMMC flap reconstruction as part of head and neck cancer surgery and control group of 20 patients who had undergone MRND(IJV & SAN sparing) without PMMC flap in same period were included. All patients were assessed at 3rd and 6th month following completion of surgery using subjective (Shoulder Disability Questionnaire) and objective (goniometer and manual muscle testing) parameters. 40 patients were included in the study, 33 (82.5%) male and 7 (17.5%) female with a mean age of 49 years with stage III/IV carcinoma In Group-1 and Group-2 the shoulder disability decreased significantly after physiotherapy intervention and also at 6thmonth postoperatively both groups showed improvements in shoulder range of motion and muscle strength. Harvesting of PMMC flap does not intensify the morbidity of shoulder which is common in RND and during MRND. A regimen of home-based exercises and patient education are effective tools to reduce shoulder disability and improving shoulder function.
目的是比较头颈癌患者在进行改良根治性颈清扫术时，带与不带胸大肌肌皮瓣（PMMC）切取情况下肩部功能的发病率，以确定PMMC皮瓣切取对肩部功能的影响，同时确定物理治疗的效果。材料与方法：前瞻性研究，涉及两组，研究组为20例进行改良根治性颈清扫术的患者，将PMMC皮瓣重建作为头颈癌手术的一部分；同期纳入20例接受了改良根治性颈清扫术（保留颈内静脉和副神经）且未切取PMMC皮瓣的患者作为对照组。所有患者在手术完成后的第3个月和第6个月，使用主观（肩部残疾问卷）和客观（角度计和徒手肌力测试）参数进行评估。40例患者纳入研究，33例（82.5%）为男性，7例（17.5%）为女性，平均年龄49岁，患有III/IV期癌症。在第1组和第2组中，物理治疗干预后肩部残疾显著降低，术后第6个月两组的肩部活动范围和肌肉力量均有所改善。切取PMMC皮瓣不会加剧在根治性颈清扫术和改良根治性颈清扫术中常见的肩部发病率。一套以家庭为基础的锻炼方法和患者教育是减少肩部残疾和改善肩部功能的有效手段。
