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

摘要：

目的 通过网状Meta分析评价8种康复疗法对颈淋巴结清扫术后患者颈肩功能的影响。方法 检索中英文数据库中关于康复训练对颈淋巴结清扫术后患者颈肩功能影响的随机对照试验，检索时限为建库至2022年4月，由2名研究者独立进行检索及资料提取。采用Review Manager 5.3进行文献质量评价，采用ADDIS1.16.8软件进行网状Meta分析。结果 纳入22项随机对照试验，共1 407例患者，8种康复疗法。网状Meta分析结果表明，在肩关节功能评价指标方面，术中神经肌肉电刺激（P=0.040）、颈肩有氧操（P=0.020）、阶梯式联合运动（有氧运动+抗阻运动）（P=0.009）、太极拳（P=0.040）、针灸（P=0.030）优于常规康复方法；在颈淋巴结清扫损伤指数方面，仅针灸（P=0.020）优于常规康复方法；在肩关节疼痛和功能恢复评价指标方面，仅阶梯式联合运动（有氧运动+抗阻运动）（P=0.030）优于常规康复方法；在肩部活动度（肩屈曲、肩外展）方面，各运动类型间两两比较，差异均无统计学意义（P>0.05）；在颈部向患侧屈曲方面，阶梯式联合运动（有氧运动+抗阻运动）（P=0.004）、颈肩有氧操（P=0.008）、太极拳（P=0.006）、穴位疗法（P=0.010）优于常规康复方法；在颈部向健侧屈曲方面，颈肩有氧操（P=0.040）、穴位疗法（P=0.030）优于常规康复方法；在颈部向健侧旋转方面，颈肩有氧操（P=0.020）优于常规康复方法；在颈部向患侧旋转方面，颈肩有氧操（P=0.030）优于常规康复方法。结论 8种康复疗法中针灸主要在降低患者肩部疼痛，提高其参与社会活动能力方面，阶梯式联合运动（有氧运动+抗阻运动）主要在恢复患者肩关节功能障碍方面，颈肩有氧操主要在提高患者颈部活动度方面各自具有优势，但该研究存在一定的局限性，结论仍需进一步验证。

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