Mvement training of shoulder after radical clearance of cervical lymph nodes on malignant tumor of maxillofacial region

摘要

Background:Radical clearance of cervical lymph nodes is an effective method to treat malignant tumor of maxillofacial region and prevent diffusion and relapses.But postoperative contour and dysfunction of shoulder due to dysfunction of trapezius muscle that is caused by injury of accessory nerve affect patients' lining qualinty.Objective:To explore therapeutic method of dysfunction of shoulder after radical clearance of cervical lymph nodes of maxilloracial region.Unit:Oral Medical College,Fourth Military Medical University.Subjects:21 males and 17 females aged 49-71 years old were investigated,among which were 14 cases of carcinoma of tongue,1 cases carcinoma of cheek,9 cases of carcinoma of gingival ,others,5 cases.All cases were treated by radical clear ance of unilateral cervical lymph nodes.Intervention:(1)Local massage:Affected trapezius muscle region was massaged from 2th day after operation.Soft concentric massage and local rubbing were taken by nurses and families,times every day to prevent atrophy or muscles.(2)Passive and active movement training:Moving training began within 1 week,Passive training of shoulder was taken t first,under instruction of nurses and cooperation of families,including shrugging of shoulder,elevation and abduction of upper limb.Same moving was taken under instruction to healthy shoulder to experience voluntary moving.If atrophy of affected trapezius muscle was obsered.active movement training was taken supplied with passive moving and transited to active moving successively,3-5 times every day and 5-10 minutes every time.(3)Occupational training:Occupational training was to take muscle exercises using functional movement of shoulder which effect was superior to simple muscle exerciese.When antagonistic effect was found,fitful external force was adopted to antagonist moving of affected shoulder and promote recovery of muscle.(4)Physical therapy:Local radiation infrared ray was adopted 1 week after operation,once a day,2 weeks as a therapeutic course and kept for 3-5 therapeutic courses.Results:Dysfunction evaluation of affected shoulder after 6 months of follow-up survey.Affected degrees were divided into 4 grades;Grade I,no influence compared with that before operation,3 cases;Grade,Ⅱ,mild influence,20 cases;Grade Ⅲ，moderate influence,13 cases;Grade Ⅳ ,serious influence, cases ,Function evaluation of shrugging,evaluawtion abductor of upper limb,patients could accomplish common moving besides 2 cases of patients with grade Ⅳ.Conchlusion:Systematic rehabilitation nursing could effectively promote recovery of postoperative function of affected shoulder.