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口腔颌面部恶性肿瘤颈淋巴清扫术后肩臂综合征的评估与康复管理专家共识

Expert consensus on the evaluation and rehabilitation management of shoulder syndrome after neek dissection for oral and maxillofacial malignancies

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【作者】 李家存； 孙沫逸； 任皎洁； 郭伟； 李龙江； 唐瞻贵； 任国欣； 孙志军； 孟箭； 尚伟； 刘绍严； 张杰； 李吉辰； 何悦； 李春洁； 杨凯； 龚忠诚； 席庆； 韩冰； 麦华明； 陈彦平； 章杰； 吴亚东； 李超； 安常明； 孙传政； 袁华； 杨帆； 袁海光； 吴丹冬； 范帅； 李飞； 徐超； 魏伟；

【Author】 LI Jiacun;SUN Moyi;REN Jiaojie;GUO Wei;LI Longjiang;TANG Zhangui;REN Guoxin;SUN Zhijun;MENG Jian;SHANG Wei;LIU Shaoyan;ZHANG Jie;LI Jicheng;HE Yue;LI Chunjie;YANG Kai;GONG Zhongcheng;XI Qing;HAN Bing;MAI Huaming;CHEN Yanping;ZHANG Jie;WU Yadong;LI Chao;AN Changming;SUN Chuanzheng;YUAN Hua;YANG Fan;YUAN Haiguang;WU Dandong;FAN Shuai;LI Fei;XU Chao;WEI Wei;State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Key Laboratory of Stomatology,Department of Medical Rehabilitation,The Third Hospital Affiliated of Air Force Military Medical University;State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Key Laboratory of Stomatology,Department of Maxillofacial Oncology,The Third Hospital Affiliated of Air Force Military Medical University;Department of ear-nose-throat medicine,Shaanxi Traditional Chinese Medicine Hospital;Department of Oral and Maxil-lofacial Surgery,Shanghai Ninth People’s Hospital,Shanghai jiaotong University School of Medicine;State Key Laboratory of Oral Diseases,National Center for Stomatology,National Clinical Research Center for Oral Dis-eases,Department of Head and Neck Oncology,West China Hospital of Stomatology,Sichuan University;Xiangya Medical School of Stomatology,Central South University;School of Stomatology Wuhan University;Xuzhou Central Hospital;Department of Oral and Maxillofacial Surgery,Affiliated Hospital of Qingdao University;Head and Neck Surgery,Cancer Hospital Chinese Academy of Medical Sciences;Department of Oral and Maxillofacial Surgery,Peking University School of Stomatology;The First Affiliated Hospital of Harbin Medical University;Department of Oral and Maxillofacial Surgery,The First Afiliated Hospital of Chongqing Medical University;School of Stomatology,Xinjiang Medical University;Department of Stomatology,First Medical Center of PLA General Hospital;Department of Oral and Maxillofacial Surgery,School and Hospital of Stomatology,Jilin University;Hospital of Stomatology,Guangxi Medical University;The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital;Department of Oral and Maxillofacial Surgery,The First Afiliated Hospital of Nanchang University;School of Stomatology,Guizhou University;Department of Head and Neck Surgery,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital & Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China;Department of Head and Neck Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College;Department of Head and Neck Surgery Section II,the Third Affiliated Hospital of Kunming Medical University(Yunnan Cancer Hospital);Department of Rehabilitation Medicine,Xijing Hospital,the Airforce Military Medical University;Department of Acupuncture and Moxibustion II,The Affiliated Hospital of Shaanxi University of Chinese Medicine;Department of Rehabilitation Medicine The First Affiliated Hospital of Chongqing Medical University;Department of Rehabilitation Medicine,The third Xiangya Hospital,Central South University;Department of Rehabilitation Medicine,the First Medical Center,Chinese PLA General Hospital;Department of Rehabilitation Medicine,The First Affiliated Hospital of Guangxi Medical University;Department of Rehabilitation Medicine,Yantaishan Hospital Affiliated to Binzhou Medical University;

【通讯作者】 孙沫逸;

【机构】 口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔疾病临床医学研究中心,空军军医大学第三附属医院医疗康复科； 口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔疾病临床医学研究中心,空军军医大学第三附属医院口腔颌面头颈肿瘤科； 陕西省中医医院耳鼻喉科； 上海交通大学医学院附属第九人民医院口腔颌面-头颈肿瘤科； 四川大学口腔疾病国家重点实验室,国家口腔疾病研究临床中心,华西口腔医院头颈肿瘤外科； 中南大学湘雅口腔医院； 武汉大学口腔医学院； 徐州市中心医院； 青岛大学附属医院口腔颌面外科； 中国医学科学院肿瘤医院头颈外科； 北京大学口腔医学院口腔颌面外科； 哈尔滨医科大学附属第一医院； 重庆医科大学附属第一医院口腔颌面外科； 新疆医科大学口腔医学院； 解放军总医院第一医学中心口腔科； 吉林大学口腔医院口腔颌面外科； 广西医科大学附属口腔医院； 河北医科大学第四医院暨河北省肿瘤医院； 南昌大学第一附属医院口腔颌面外科； 贵州医科大学口腔医学院； 四川省肿瘤医院头颈外科； 国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院头颈外科； 昆明医科大学第三附属医院(云南省肿瘤医院)头颈外二科； 空军军医大学西京医院康复医学科； 陕西中医药大学附属医院针灸二科； 重庆医科大学附属第一医院康复医学科； 中南大学湘雅三医院康复科； 解放军总医院第一医疗中心康复医学科； 广西医科大学第一附属医院康复医学科； 滨州医学院附属烟台山医院康复医学科；

【摘要】 颈淋巴清扫术（ND）是口腔颌面部恶性肿瘤治疗的主要方法之一。尽管颈清术式在不断改良，但术中因剥离、牵拉等损伤副神经、肌肉、肌膜、筋膜及韧带引起的肩臂综合征（SS），仍是患者术后常见并发症，加之放疗的影响，不仅会导致患者肩颈及手臂疼痛、僵硬、麻木、活动受限等功能障碍，更会对患者的生存质量和身心健康产生严重影响。目前，国内外针对口腔颌面部恶性肿瘤颈清术后SS的问题尚缺乏一个系统评估和康复管理方案。基于前期临床实践基础以及当前可获得的最佳证据，参考国内外相关文献，邀请颌面肿瘤外科和康复领域的专家根据相关临床经验共同讨论、修改，从SS的病因、评估、诊断与鉴别诊断、康复策略及预防等方面达成共识，以期为临床提供参考。

【Abstract】 Neck dissection(ND) is one of the main treatment methods for oral and maxillofacial malignancies. Although ND type is in constant improvement, but intraoperative peal-pull-push injury of the accessory nerve, muscle, muscle membrane, fascia and ligament induced shoulder syndrome(SS) is still a common postoperative complication, combined with the influence of radiochemotherapy, not only can cause pain, stiffness, numbness, limited dysfunction of shoulder neck and arm, but also may have serious impact on patient’s life quality and physical and mental health. At present, there is still a lack of a systematic evaluation and rehabilitation management program for postoperative SS of oral and maxillofacial malignant tumors. Based on the previous clinical practice and the current available evidence, refer to the relevant literature at home and abroad, the experts in the field of maxillofacial tumor surgery and rehabilitation were invited to discuss, modify and reach a consenusus on the etiology, assessment diagnosis, differential diagnosis, rehabilitation strategy and prevention of SS, in order to provide clinical reference.

【关键词】 口腔颌面部肿瘤； 颈淋巴清扫术； 肩臂综合征； 康复管理；
【Key words】 Oral and maxillofacial tumors； Neck dissection； Shoulder-arm syndrome； Rehabilitation management；
【基金】 国家口腔疾病临床医学研究中心专项课题A类项目(编号：LCA202016);空军军医大学第三附属医院新技术新业务(编号：LX2021-402)
  • 【文献出处】 实用口腔医学杂志 ,Journal of Practical Stomatology , 编辑部邮箱 ,2024年05期
  • 【分类号】R739.8
  • 【下载频次】30
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