Yang Ling, Hao Guihua, Yang Wenyu, Hou Lili
Department of Nursing, Chengdu Xinhua Hospital, Chengdu, China.
Department of Nursing, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Stomatol Oral Maxillofac Surg. 2025 Jun;126(3):102104. doi: 10.1016/j.jormas.2024.102104. Epub 2024 Oct 2.
To compare the effects of starting mouth opening exercises at two different times on trismus in postoperative radiotherapy patients with oral cancer.
Through a prospective randomized controlled trial, purposive sampling was used to select 76 patients undergoing postoperative radiotherapy for oral cancer from March 2023 to January 2024 at the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Patients were randomly divided into an experimental group (n = 38) and a control group (n = 38) using a random number table at a ratio of 1:1. The experimental group began mouth opening exercises in the second week after surgery (before radiotherapy), while the control group began in the fourth week after surgery (at the start of radiotherapy). The primary outcome measure was maximum interincisal opening (MIO). Secondary outcome measures included pain visual analog scale (VAS) scores and quality of life scores (UW-QOL), assessed at baseline, the second week post-surgery (before radiotherapy), the fourth week post-surgery (at the start of radiotherapy), the ninth week post-surgery (end of radiotherapy), and the twelfth week post-surgery (three weeks after the end of radiotherapy).
A total of 72 patients completed all assessments, with 36 in each group, resulting in an overall sample attrition rate of 5.26 % (less than 15 %). There were no statistically significant differences in general demographic and clinical characteristics between the two groups. Repeated measures ANOVA showed significant differences in MIO, VAS, and UW-QOL scores between groups, over time, and in group-time interactions (P < 0.001). From the fourth week post-surgery (at the start of radiotherapy), the experimental group had significantly higher MIO (P < 0.001), significantly lower VAS scores (P < 0.001), and significantly higher UW-QOL scores (P < 0.001) compared to the control group. These differences persisted at subsequent assessment points.
Initiating mouth opening exercises in the second week post-surgery (before radiotherapy) can significantly improve mouth opening, reduce pain, and enhance the quality of life in postoperative radiotherapy patients with oral cancer. This provides important evidence for clinical practice, although further research is needed to verify the long-term effects.
比较在两个不同时间开始进行张口练习对口腔癌术后放疗患者牙关紧闭的影响。
通过前瞻性随机对照试验，采用目的抽样法，选取2023年3月至2024年1月在上海交通大学医学院附属第九人民医院口腔颌面外科接受口腔癌术后放疗的76例患者。使用随机数字表按1:1的比例将患者随机分为实验组（n = 38）和对照组（n = 38）。实验组在术后第二周（放疗前）开始进行张口练习，而对照组在术后第四周（放疗开始时）开始。主要观察指标为最大切牙间开口度（MIO）。次要观察指标包括疼痛视觉模拟量表（VAS）评分和生活质量评分（UW-QOL），在基线、术后第二周（放疗前）、术后第四周（放疗开始时）、术后第九周（放疗结束时）和术后第十二周（放疗结束后三周）进行评估。
共有72例患者完成了所有评估，每组各36例，总体样本流失率为5.26%（小于15%）。两组在一般人口统计学和临床特征方面无统计学显著差异。重复测量方差分析显示，两组之间、随时间以及组间时间交互作用在MIO、VAS和UW-QOL评分方面存在显著差异（P < 0.001）。从术后第四周（放疗开始时）起，与对照组相比，实验组的MIO显著更高（P < 0.001），VAS评分显著更低（P < 0.001），UW-QOL评分显著更高（P < 0.001）。这些差异在后续评估点持续存在。
术后第二周（放疗前）开始进行张口练习可显著改善口腔癌术后放疗患者的张口度，减轻疼痛，并提高生活质量。这为临床实践提供了重要证据，尽管需要进一步研究来验证长期效果。
