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 \n改善效果  \n曾健1, 2，张慧果2, 3，廖冰1, 2，陆璨1, 2  \n(1 .中南大学湘雅医院临床护理学教研室，长沙410008； 2.中南大学湘雅医院口腔医学中心颌面外科，长沙410008； 3.中南大学湘雅护理学院，长沙410013)  \n[摘要] 目的： 口腔癌患者颈淋巴结清扫术后出现肩综合征较为常见，现有康复方案多为阶段性固定训练，缺乏基于患者实时状态的动态调整机制。本研究旨在探讨结构化康复训练方案对口腔癌颈淋巴结清扫术后患者肩综合征的改善效果，为临床制订精准化康复干预策略提供依据。 方法：纳入2023年6月至2024年6月在中南大学湘雅医院口腔医学中心颌面外科接受口腔癌手术并行颈淋巴结清扫术的患者98例，随机分为结构化康复组和常规康复组，结构化康复组56例，常规康复组42例。结构化康复组实施结构化评估的阶段性康复训练方案，常规康复组采用常规康复方案。采用Constant-Murley肩功能评分(Constant‐Murley Score， CMS)、 视觉模拟评分法(Visual Analogue Scale， VAS)于术后2周、3个月、6个月对患者进行评估，比较2组评分差异。 结果：结构化康复组患者术后3、 6个月CMS 显著优于常规康复组(均P\u003C0 .001)，且Ⅴ区颈部淋巴结清扫术后患者CMS改善更早。结构化康复组术后6个月VAS评分较常规康复组明显降低(P\u003C0 .001)， Ⅴ区亚组优势更突出。多因素回归分析进一步证实，结构化康复干预是术后3个月及6个月肩功能与疼痛改善的独立影响因素(均P\u003C0 .001)。 亚组分析显示，Ⅲ区颈淋巴结清扫患者虽在术后3个月 CMS及VAS评分改善不显著，但术后6个月Ⅲ区及V区的CMS及VAS评分均显著优于常规康复组(均P\u003C0 .001)，表明结构化康复方案对不同清扫范围的患者均具有长期改善效果。 结论：基于结构化评估的康复训练方案可显著改善口腔癌颈淋巴结清扫术后患者的肩关节功能，有效缓解肩综合征，减轻疼痛。  \n[关键词] 口腔癌；颈淋巴结清扫术；肩综合征；结构化康复训练；疼痛  \nEffects of structured rehabilitation training on shoulder syndrome after cervical lymph neck dissection inpatients with oral cancer  \nZENG Jian1, 2, ZHANG Huiguo2, 3, LIAO Bing1, 2, LU Can1, 2  \n(1. Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha 410008;  \n2. Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha 410008; 3. Xiangya School of Nursing, Central South University, Changsha 410013, China)  \nABSTRACT Objective: Shoulder dysfunction syndrome is common in patients with oral cancer after  \n收稿日期(Date of reception)：2026-01-20  \n第一作者(First author)：曾健，Email: [zengjian@csu.edu.cn](zengjian@csu.edu.cn), ORCID: 0009-0005-4743-6818  \n通信作者(Corresponding author)：陆璨，副主任护师，Email: [lucan520@csu.edu.cn](lucan520@csu.edu.cn), ORCID: 0000-0002-9836-8289  \n基金项目(Foundation item)：湖南省自然科学基金(2024JJ5587)。 This work was supported by the Natural Science Foundation of Hunan Province, China (2024JJ5587) .  \n开放获取(Open access)：本文遵循知识共享许可协议，允许第三方用户按照署名-非商业性使用-禁止演绎4 .0(CC BY-NC-ND 4.0)的方式，在任何媒介以任何形式复制、传播本作品([https://creativecommons.org/licenses/by-nc-nd/4.0/](https://creativecommons.org/licenses/by-nc-nd/4.0/))。  \n©Journal of Central South University (Medical Science) . All rights reserved.  \nneck dissection. Existing rehabilitation programs are mostly based on fixed stage-specific exercises and lack dynamic adjustment mechanisms according to patients ’ real-time conditions. This study aims to investigate the effects of a structured rehabilitation training program on shoulder dysfunction syndrome in patients after neck dissection for oral cancer and to provide evidence for the development of precise rehabilitation strategies in clinical practice.  \nMethods: A total of 98 patients who underwent oral cancer surgery with neck dissection atthe Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital of Central South University, between June 2023 and June 2024 were enrolled and randomly assigned to either a structured rehabilitation group or a conventional rehabilitation group. The structured rehabilitation group included 56 patients and received a stage-based rehabilitation program guided by structured assessments, whereas the conventional rehabilitation group included 42 patients and received standard rehabilitation training. The Constant-Murley Score (CMS) and Visual Analogue Scale (VAS) were used to evaluate patients at 2 weeks, 3 months, and 6 months postoperatively. Differences in scores between the 2 groups were compared.  \nResults: Compared with the conventional rehabilitation group, patients in the structured rehabilitation group showed significantly better CMS at 3 and 6 months after surgery (P\u003C0 .001) . Moreover, patients undergoing level V neck dissection exhibited earlier improvement in shoulder function scores. At 6 months postoperatively, VAS scores in the structured rehabilitation group were significantly lower than those in the conventional rehabilitation group (P\u003C0 .001), with a more pronounc","cbCaicYxOZIXJkNB","https://ap.wps.com/l/cbCaicYxOZIXJkNB","pdf",1224413,"Chinese","en","# 对象与方法\n## 伦理声明\n## 对象及分组\n# 评估与干预\n## 康复训练方案\n## 结局指标与随访时间","[{\"question\":\"研究的目的是什么？\",\"answer\":\"旨在探讨结构化康复训练方案对口腔癌颈淋巴结清扫术后肩综合征的改善效果，并为临床制定精准化康复干预策略提供依据。\"},{\"question\":\"研究如何评价肩关节功能与疼痛？\",\"answer\":\"采用Constant-Murley肩功能评分（CMS）和视觉模拟评分法（VAS），在术后2周、3个月、6个月对患者进行评估并比较两组差异。\"},{\"question\":\"结构化康复训练相比常规康复有哪些主要结果？\",\"answer\":\"结构化康复组在术后3个月和6个月的CMS显著优于常规康复组；同时，术后6个月VAS评分较常规组明显降低，且不同清扫范围亚组表现存在差异与长期获益。\"}]","结构化康复训练对口腔癌颈淋巴结清扫术后肩综合征的改善效果 | PDF",1790139753,25]