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Effect of Myofascial Release Technique for Postoperative Treatment of Stage Ⅲ Upper Limb Lymphedema in Patients with Breast Cancer
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摘要:
目的 探究肌筋膜松解手法在乳腺癌患者术后Ⅲ期淋巴水肿治疗中的应用效果。 方法 回顾性收集2016年1月至2021年12月于北京协和医院康复医学科就诊的乳腺癌相关Ⅲ期淋巴水肿患者的临床资料。根据治疗方式不同, 将患者分为手法治疗组和常规治疗组。常规治疗组予以常规绷带加压联合运动训练治疗, 手法治疗组在绷带加压、运动训练前予以肌筋膜松解手法, 两组均每周治疗2~3次, 共治疗25~30次。分别于治疗前、治疗结束、治疗结束后3个月评估两组患者的患肢体积、疼痛程度、关节活动度(range of motion, ROM)以及肢体功能, 其中患肢体积为主要结局指标。 结果 共入选79例符合纳入和排除标准的乳腺癌相关Ⅲ期淋巴水肿患者, 其中常规治疗组39例、手法治疗组40例。两组治疗前患肢体积、视觉模拟评分(visual analogue scale, VAS)、前屈与外展ROM、上肢功能障碍评定量表(disability arm shoulder hand, DASH)评分均无显著性差异(P均＞0.05)。与常规治疗组比较, 手法治疗组治疗结束[(2511.70±437.08)cm3比(2823.58±537.60)cm3, P=0.006]、治疗结束后3个月[(2492.91±446.52)cm3比(2813.90±533.87)cm3, P=0.005]患肢体积均减小, VAS、DASH评分均降低(P均＜0.05), 治疗结束后3个月患肢前屈与外展ROM均增大(P均＜0.05)。线性回归分析显示, 手法治疗组治疗后患肢体积相较于治疗前的平均减小量比常规治疗组多156.260 cm3(95% CI: 124.264~188.255, P＜0.001), VAS评分平均减小值比常规治疗组多0.557(95% CI: 0.163~0.951, P=0.006), DASH评分平均减小值比常规治疗组多16.590(95% CI: 12.270~20.911, P＜0.001);手法治疗组治疗后患肢前屈ROM相对于治疗前的平均增加度数比常规治疗组多7.390(95% CI: 2.016~12.763, P=0.007), 外展ROM平均增加度数比常规治疗组多12.737(95% CI: 6.320~19.153, P＜0.001)。 结论 肌筋膜松解手法可能与乳腺癌患者Ⅲ期淋巴水肿体积减小有关, 并可能在一定程度上缓解疼痛, 恢复关节功能。 Abstract:Objective To explore the effect of myofascial release technique in the treatment of stage Ⅲ lymphedema after breast cancer surgery. Methods The clinical data of breast cancer-related stage Ⅲ lymphedema patients treated in the Department of Rehabilitation Medicine of Peking Union Medical College Hospital from January 2016 to December 2021 were retrospectively collected. According to different treatment methods, the patients were divided into manual therapy group and conventional therapy group. The conventional therapy group was treated with conventional bandage compression combined with exercise training, while the manual therapy group was treated with myofascial release technique before bandage compression and exercise training. Both groups were treated 2-3 times a week, 25-30 times in total. Limb volume, pain, range of motion (ROM), and limb function were evaluated before treatment, at the end of treatment, and 3 months after treatment, with limb volume as the primary outcome index. Results A total of 79 breast cancer patients with stage Ⅲ lymphedema who met the inclusion and exclusion criteria were enrolled, including 39 in the conventional therapy group and 40 in the manual therapy group. There was no significant difference in limb volume, visual analogue scale (VAS) score, flexion and abduction ROM, and disability arm shoulder hand (DASH) score between the two groups before treatment (all P > 0.05). Compared with the conventional therapy group, the affected limb volume in the manual therapy group was reduced at the end of treatment[(2511.70±437.08)cm3 vs. (2823.58±537.60)cm3, P=0.006] and 3 months after treatment[(2492.91±446.52)cm3 vs. (2813.90±533.87)cm3, P=0.005], and VAS and DASH scores were decreased (all P < 0.05), while the anteriorflexion and abduction ROM of the affected limb were increased 3 months after treatment (all P < 0.05). Linear regression analysis showed that in the manual therapy group the mean reduction of limb volume after treatment was 156.260 cm3(95% CI: 124.264-188.255, P < 0.001) more than that in the conventional therapy group; the mean reduction of VAS score was 0.557(95% CI: 0.163-0.951, P=0.006) more than that in the conventional therapy group; and the mean reduction of DASH score was 16.590(95% CI: 12.270-20.911, P < 0.001) more than that in the conventional therapy group; the average increase of anteriorflexion ROM was 7.390(95% CI: 2.016-12.763, P=0.007) more than that in the conventional therapy group, and the average increase of abduction ROM was 12.737(95% CI: 6.320-19.153, P < 0.001) more than that in the conventional therapy group. Conclusions Myofascial relaxation may be associated with the reduction of the volume of stage Ⅲ lymphedema in patients with breast cancer. It can relieve pain and restore joint function to a certain extent. -
Key words:
- breast cancer /
- lymphedema /
- myofascial release /
- rehabilitation treatment
作者贡献：宋健负责论文撰写；彭理负责查阅文献；邓明负责统计学分析；刘淑芬负责数据收集；刘颖负责论文设计及审校。利益冲突：所有作者均声明不存在利益冲突 -
表 1 两组治疗前后患肢体积比较(x±s，cm3)
组别 治疗前 治疗结束 治疗结束后3个月 手法治疗组(n=40) 2808.26±471.37 2511.70±437.08 2492.91±446.52 常规治疗组(n=39) 2965.80±527.97 2823.58±537.60 2813.90±533.87 P值 0.166 0.006 0.005 F组间=5.678，P=0.020；F时间=393.531，P＜0.001；F组间×时间=48.393，P＜0.001 
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表 2 治疗前后患肢体积变化量影响因素的线性回归分析结果
指标 β值 95% CI P值 年龄 -0.255 -1.833~1.322 0.750 BMI -0.741 -7.275~5.793 0.823 手术方式 双侧乳房全切术(参照) 单侧保乳术 55.364 -62.276~173.004 0.354 单侧乳房全切术 11.648 -54.508~77.804 0.728 治疗方式 常规治疗组(参照) 手法治疗组 -156.260 -188.255~-124.264 ＜0.001 时间点 治疗结束(参照) 治疗结束后3个月 -14.291 -44.852~16.269 0.357 BMI：体质量指数
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表 3 两组治疗前后患肢前屈与外展ROM比较[M(P25, P75), °]
指标 手法治疗组(n=40) 常规治疗组(n=39) P值 前屈ROM 治疗前 170.0(163.0，180.0) 174.0(165.0，180.0) 0.282 治疗结束 180.0(175.0，180.0) 180.0(174.0，180.0) 0.235 治疗结束后3个月 180.0(180.0，180.0) 180.0(175.0，180.0) 0.005 外展ROM 治疗前 165.0(155.5，180.0) 172.0(160.0，180.0) 0.283 治疗结束 180.0(174.5，180.0) 180.0(165.0，180.0) 0.142 治疗结束后3个月 180.0(178.0，180.0) 180.0(170.0，180.0) 0.012 前屈ROM：H组间=1.6972，P=0.193；H时间=27.0897，P＜0.001；H组间×时间=5.7493，P=0.056；外展ROM：H组间=2.1355，P=0.144；H时间=19.5876，P＜0.001；H组间×时间=5.4237，P=0.066ROM：关节活动度
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表 4 两组治疗前后VAS、DASH评分比较[M(P25, P75), 分]
指标 手法治疗组(n=40) 常规治疗组(n=39) P值 VAS 治疗前 4.5(3.0，6.0) 4.0(3.0，5.0) 0.489 治疗结束 2.0(2.0，2.5) 3.0(2.0，4.0) ＜0.001 治疗结束后3个月 1.0(0.5，2.0) 3.0(2.0，4.0) ＜0.001 DASH 治疗前 63.6(55.7，79.5) 68.2(52.3，81.8) 0.593 治疗结束 22.7(30.7，19.3) 43.2(29.6，54.6) ＜0.001 治疗结束后3个月 20.5(14.8，26.2) 43.2(25.0，54.6) 0.001 VAS：H组间=20.737，P＜0.001；H时间=81.030，P＜0.001；H组间×时间= 15.904，P＜0.001；DASH：H组间=18.143，P＜0.001；H时间=97.770，P＜0.001；H组间×时间=8.534，P=0.014VAS：视觉模拟评分；DASH：上肢功能障碍评定量表
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