关键词: 颈淋巴结清扫术, 头颈部肿瘤, 康复护理, 颈肩功能, 网状Meta分析, 循证护理学

Abstract:

Objective To evaluate the effect of 8 types of rehabilitation therapies on neck and shoulder function of patients after neck dissection by network meta-analysis. Methods Randomized controlled trials（RCTs） on the effects of rehabilitation training on neck and shoulder function of patients after neck dissection were retrieved from Chinese and English databases. The retrieval time was from the establishment of the database to April 2022，and the retrieval was independently conducted by 2 researchers.Review Manager 5.3 was used for quality assessment，and ADDIS 1.16.8 software was used for network meta-analysis. Results 22 randomized controlled trials（RCTs） were included，with 1407 patients and 8 types of rehabilitation therapy.The results of network meta-analysis showed that in terms of Constant-Murley Score，the brief electrical stimulation（P=0.040），neck and shoulder aerobic exercise（P=0.020），step combined exercise（aerobic+resistance）（P=0.009），Tai Chi（P=0.040）and acupuncture（P=0.030） were better than conventional rehabilitation. In terms of Neck Dissection Impairment Index，only acupuncture（P=0.020） was better than conventional rehabilitation methods. In terms of Shoulder Pain and Disability Index，only stepwise combined exercise （aerobic + resistance）（P=0.030） was better than conventional rehabilitation methods. In terms of shoulder range of exercise（shoulder flexion，shoulder abduction），there was no significant difference between the pairwise comparisons among the exercise types（P>0.05）.In terms of neck flexion to the affected side，stepwise combined exercise（aerobic exercise + resistance exercise）（P=0.004），neck and shoulder aerobic exercise（P=0.008），Tai Chi（P=0.006），and acupoint therapy（P=0.010） were better than conventional rehabilitation methods. In terms of flexion of the neck to the contralateral side，neck and shoulder aerobics （P=0.040） and acupoint therapy（P=0.030） were better than conventional rehabilitation methods. In terms of rotation of the neck to the contralateral side，neck and shoulder aerobics（P=0.020） was better than conventional rehabilitation methods. In the rotation of the neck to the affected side，neck and shoulder aerobics（P=0.030） was better than conventional rehabilitation methods. Conclusion Among the 8 rehabilitation therapies，acupuncture and moxibustion can mainly reduce shoulder pain and improve their ability to participate in social activities. Step combined exercise（aerobic + resistance） mainly has advantages in restoring shoulder joint dysfunction，and neck and shoulder aerobic exercise mainly has advantages in improving neck range of motion. However，due to the limitations of this study，further verification is still needed.

Key words: Neck Dissection, Head and Neck Neoplasms, Rehabilitation Nursing, Neck and Shoulder Function, Network Meta-Analysis, Evidence-Based Nursing