乳腺癌术后康复训练操对患者上臂水肿及肩关节活动的影响

目的:对乳腺癌患者运用青岛大学医学院第二附属医院乳腺外科自行编制的康复训练操训练,观察其术后患侧上臂水肿的发生率及肩关节的活动度。方法:青岛大学医学院第二附属医院乳腺外科2003-09/2004-07收治女性乳腺癌患者200例(Ⅰ～Ⅲ期,均经病理证实),随机分为对照组(60例)和康复训练组(140例)。对照组不进行康复操训练,只自行锻练。康复训练组,运用青岛大学医学院第二附属医院乳腺外科自制的康复训练操,辅以音乐进行康复训练。该康复训练操共分五部分,分别表示术后1周内、2周内、3周内、4周内及术后1个月以上5个时段,每部分分4节。测量患侧上肢水肿犤标准:术后首次换药(排除包扎过紧造成水肿)后出现患侧上肢胀痛;患侧上肢较另一侧上肢肿大;压之有凹陷犦发生率,观察术前、术后1,2,3个月肩关节的活动度,上肢的前、后、侧方上举角度,内外方旋转角度。结果:按意向处理分析,200例患者均进入结果分析。①两组患者肩关节活动度测量结果比较:术后3个月康复组的前方上举、后方上举、侧方上举、外旋、内旋均明显高于对照组犤(106.0±1.0)°,(49.0±2.0)°,(85.0±1.0)°,(61.0±1.0)°,(83.0±1.0)°;(48.1±2.0)°;(46.2±1.0)°,(59.5±4.0)°,(58.3±1.0)°,(49.1±1.0)°,t=6.32-1.56,P<0.05犦。②两组患者患侧上臂水肿发生率:术后1,2个月时康复训练组上肢水肿的发生率比对照组明显降低犤(7%,32%),u=4.42,P<0.05;(2%,15%),u=3.94,P<0.05犦。结论:康复训练操能有规律地活动上肢肌肉,促进局部血液循环和淋巴回流,使患侧上肢水肿减轻,肩关节的活动度及功能障碍明显改善。     

肩关节脱位关节镜术后患者的康复训练

目的探讨肩关节镜治疗肩关节脱位的术后康复锻炼方法。方法对35例肩关节镜治疗肩关节脱位患者,加强术后的康复训练:患肢保护,肌力、活动度和肌肉牵张训练等。采用UCLA(加州大学洛杉矶分校)评分标准,根据肩关节的疼痛、功能、主动向前上举的角度、肌力及患者的主观满意度进行评分。随访7~40个月,平均15个月。结果35例患者均无术后感染及肩关节粘连发生,肩关节疼痛明显改善,手术疗效满意。UCLA评分由术前平均18.3分改善至术后31.5分。结论本康复计划是肩关节镜治疗肩关节脱位术后的有效康复方法。     

康复训练应用于乳腺癌术后患者的实践

目的探讨减轻乳腺癌术后患者上肢机能障碍的康复训练方法.方法回顾性分析86例行康复训练的乳腺癌术后患者及79例未行康复训练的乳腺癌术后患者的临床资料,进行有序分组计数资料的Pearson χ2检验.结果康复训练组患者上肢淋巴水肿、肩关节运动幅度受限、肌力低下,精细运动功能障碍的发生率明显低于对照组(P均＜0.05),但运动后迅速出现疲劳两组差异无显著性意义(P＞0.05).结论乳腺癌术后康复训练,可明显降低上肢机能障碍的发生率.     

乳腺癌患者术后康复训练虚拟现实系统的设计及应用

利用并集成高性能的计算机软硬件及各类先进的传感器,开发了乳腺癌患者术后康复训练虚拟现实系统,根据淋巴水肿的变化和运动功能的情况,将康复训练分为4期。选取浙江省某三级甲等医院的单侧或双侧乳腺癌改良根治术后患者76例作为研究对象,按照患者住院号的单双号分为试验组与对照组,每组各38例。试验组通过虚拟现实系统协助患者进行患肢功能康复训练;对照组采用护士示范结合乳腺癌康复操相关视频进行患肢功能康复训炼。观察两组患侧肢体功能恢复情况、康复训练的依从性和患侧肢体水肿情况。结果表明,试验组肩关节活动度明显优于对照组,差异有统计学意义（P<0.01）;试验组康复训练的依从性及患侧肢体水肿程度优于对照组,差异有统计学意义（P<0.05）。虚拟现实系统辅助治疗以游戏参与的形式控制患者的肢体训练过程,可帮助患者肢体功能恢复。     

手术设计及康复锻炼对乳腺癌患者术后患侧上肢功能康复的影响

目的:探寻理想的乳腺癌手术技巧和术后患侧上肢功能康复的方法,以便尽可能地保证术后患侧上肢功能的康复。方法:对520例乳癌患者从手术切口设计尽可能避免伸入腋窝、适度的腋窝清扫,并尽量保护神经,术后第天即开始进行手、腕、肘部的主动运动1(屈、伸和旋转),肩关节的小范围前屈、后伸及旋转锻炼,逐渐增加活动量,10d后开始外展肩关节,并在墙上进行摸高锻炼。及时处理并发症,放射治疗在术后3个月以后进行。术后6个月时评价并记录功能恢复满意度。结果:患肢功能恢复满意度为96.0%499/520):460例88.5%,((460/520)满意,39例7.5%,39/520)基本满意,21例4.0%,21/((520)不满意。结论:从设计治疗计划开始,就应考虑患肢功能的临床康复,并在术后指导患者进行正确的康复锻炼,使患侧上肢功能得到最大限度的康复。     

婚姻质量对乳腺癌术后患者日常生活活动能力的影响

目的:调查婚姻质量对乳腺癌术后患者日常生活活动能力activitiesof(dailyliving,ADL)的影响,寻找其规律性。方法:64例乳腺癌患者术后半年接受'婚姻质量问卷和改良巴氏Olson指数评定量表(modifiedbarthelindex,MBI)调查。结果:64例乳腺癌患者术后半年的平均MBI评分为81.6±23.2)分。(按ADL能力分组后,ADL正常组(MBI≥95分)为31例,ADL缺陷组(MBI<95分)为33例。在夫妻之间内容分量表比较中,ADL正常组的夫妻交流32.93±6.95)(、性生活(34.56±7.41)、角色平等29.74±7.36)(、性格相容性31.25±7.13)、解决冲突方式29.48±8.66)等分量表评((分明显高于ADL缺陷组(t=2.065～2.934,P<0.01～0.05)。在家庭方面分量表比较中,两组间的子女和婚姻、与亲友关系、经济安排等分量表评分差异无显著性意义t=0.463～0.927,P均>0.05)。在对(婚姻评价内容分量表比较中,ADL正常组的婚姻满意度分量表评分明显高于ADL缺陷组(t=2.037,P<0.05)。结论:乳腺癌术后患者婚姻质量评估中,有部分分量表评分对其日常生活活动能力发生重要影响。     

肩袖撕裂患者术后康复训练时机及方法对肩关节功能的影响

目的 探讨大型肩袖撕裂患者术后开展康复功能训练的时机及方法对肩关节功能的影响,为寻找康复训练实施时机及方法提供依据。方法 将2016年01月一2018年6月收治的85例大型肩袖撕裂关节镜术后患者,按入院先后顺序,以随机数字表法分为实验组43例和对照组42例。43例实验组在肩袖修补术后常规护理的基础上于术后按大型肩袖撕裂术后康复计划进行肩关节康复训练,42例对照组采用制动4-6周的传统方法进行护理。结果 85例患者均得到了随访,术后随访6个月,实验组术后肩部疼痛评分低于对照组(P<0.01),日常生活功能评定(ADL)、肩关节功能ASES(American Shoulder Elbew Surgeons’score)评分均高于对照组。肩关节活动度评定(ROM),患肩主动前屈、外展、中立位外旋、体侧内旋均较对照组明显增加(P<0.01)。结论 大型肩袖撕裂关节镜术后患者,采用肩关节制动无痛原则下,针对不同时机,采取不同康复器械及方法实施分阶段康复训炼,有利于维持肩关节的活动度(ROM),避免关节粘连,提高临床康复效果,具有十分重要的意义。     

健康教育对乳腺癌患者术后的影响

我院2004-01～2006-12共收治乳腺癌手术患者85例,健康教育对乳腺癌患者术后的影响探讨如下。1临床资料1.1一般资料本组年龄33～65(平均49)岁。其中右乳腺癌28例,左乳腺癌57例。所有患者均在臂丛麻醉下行乳腺癌根治术。1.2方法我们对85例乳腺癌手术患者在积极治疗原发病,术后控制感染等基本治疗和护理的基础上,实施了周密细致的健康教育计划。1.2.1卧位的指导指导患者术后平卧6h,头偏向一侧;6h后血压平稳,改为半卧位,利于引流和呼吸,听其主诉,及时给予帮助。1.2.2心理指导乳腺癌患者对手术造成身体外观的改变易产生焦虑、忧郁、绝望等不良情…     

集体音乐操在乳腺癌术后患侧上肢功能康复中的应用

[目的]探讨集体音乐操在乳腺癌病人术后患侧上肢功能康复中的效果.[方法]随机将126例乳腺癌病人分为实验组和对照组,实验组术后给予系统的、规范的集体音乐操康复训练,对照组给予随意的锻炼,于术前及术后4周测量两组病人肩关节活动度及生活质量.[结果]实验组肩关节活动度和生活质量均优于对照组.[结论]集体音乐操可减轻患侧上肢水肿,促进了肩关节功能的恢复,从而提高了病人的生存质量.     

集体音乐操在乳腺癌术后患侧上肢功能康复中的应用

[目的]探讨集体音乐操在乳腺癌病人术后患侧上肢功能康复中的效果。[方法]随机将126例乳腺癌病人分为实验组和对照组，实验组术后给予系统的、规范的集体音乐操康复训练，对照组给予随意的锻炼，于术前及术后4周测量两组病人肩关节活动度及生活质量。[结果]实验组肩关节活动度和生活质量均优于对照组。[结论]集体音乐操可减轻患侧上肢水肿，促进了肩关节功能的恢复，从而提高了病人的生存质量。     

超早期零对接上肢康复操对乳腺癌改良根治术后肩关节功能康复影响的研究

[目的]探讨超早期零对接上肢康复操对乳腺癌改良根治术后肩关节功能康复的影响。[方法]选择2011年10月—2014年3月入住我科的单侧乳腺癌行改良根治术的病人130例,随机分为观察组和对照组,分别采用超早期零对接上肢康复操和传统康复方法,比较两组肩关节功能恢复情况。[结果]不同时间段观察组肩关节功能恢复情况均优于对照组。[结论]超早期零对接上肢康复操可有效促进肩关节功能恢复,缩短康复时间,且无关节、肌肉等并发症发生。     

Manual therapy associated with upper limb exercises vs. exercises alone for shoulder rehabilitation in postoperative breast cancer

Our objective was to evaluate the effectiveness of manual therapy (MT) associated with upper limb (UL) exercises in women with impaired shoulder range of motion (ROM) after axillary lymph node dissection (ALND) for breast cancer. A randomized, prospective, blinded clinical trial with 131 women with a ROM <- 100° for shoulder flexion and/or abduction on the first day postoperatively were evaluated. Sixty-six women were allocated to group exercises and 65 underwent the exercises followed by MT. Shoulder ROM was measured by goniometry, and function was evaluated by the Modified-University of California at Los Angeles Shoulder Rating Scale--the UCLA Scale, in the 1st, 6th, 12th, and 18th month after surgery. The chi-square test was used for the relationship between clinical characteristics and oncological treatment between groups, and ANOVA for repeat measures was used. No difference in recovery of shoulder ROM as well as UL function was observed between groups. Improvement in ROM was gradual from the 1st to the 18th month, and the function achieving a good classification at 18th month. MT associated with exercises did not enhance the results obtained with exercises alone for shoulder ROM and ipsilateral UL function.     

品管圈活动在降低乳腺癌患者术后患侧上肢水肿发生率中的应用

目的探讨品管圈活动在降低乳腺癌患者术后患肢水肿发生率中的效果。方法成立品管圈,以降低乳腺癌患者术后患侧上肢水肿为主题,进行现状调查、要因分析、制订护理对策并实施。结果品管圈活动后乳腺癌患者术后患侧上肢水肿发生率降低(P0.01)。结论品管圈活动显著降低了乳腺癌患者术后患侧上肢水肿发生率,值得临床推广。     

Functional rehabilitation of upper limbs after operation of mastocarcinoma

Background:The aim of treatment of mastocarcinouma is to lengthen the lifetime of the patients,and improve their quality of life.Function training is very important in postoperative rehabilitation treatment for the mastocarcinoma patients.The degree than functions recover shows direct proportion to the rehabilitation training.Objective:To study the therapeutic effect of rehabilitation training after operation of mastocarcinoma.Unit:First Affiliated Hospital of Fujian Medical University. Subjects:All 58 cades were married females,with 4 cases aging 2-30 years,18 cases 31-40 years.25 cases 40-50 years,11 cases 50-78 years.In order to follow up the recovery degree of the upper limb function of the mastocarcinoma patients before and after operation,all the subjects were photographed by X-ray(LORAD-MIV type,the U.S.A.).in axis and oblique position,and in psoition of small angle or lateral psoition or amplified photograph when necessary.All the 58 cases were treated with operations including 10 cases of halsted,18 cases of improved radical operation I.12 cases of improved radical operation Ⅱ，4 cases of halsted plus cervical lymphadenectomy,14 cases of extensive resection of the tumor plus axillary lymphademectomy with the mammary maintained.Intervention:The patients were told to do motion exercises of the forearms and the elbows and exercises of making a fist both for 5-10 times once and repeat for 5-6 times with equal intervals one or two days after operation.On the 3rd day on the patients were told to lift the hand of the operational side up to the same level of the head by the hadn of healthy side,3 times once,3-4times a day.On the 4th day,the healthy hand grasped the thumb of the attacked hand and lift it up with the attacked arm in an extension state,3 times once,3-4 times a day.On the 5th day,the healthy hand supported the elbow of the attacked arm and lifted it up slowly till it was higher than the head with the attacked arm extending as straight as possible,2 times once,3-4 times a day.On the 6th day,the finger tips of the attacked side slid upward along the wall,and the height was gradually increased,2 times once,for 3-4 times.On the 7-8days,abduction of the subulder was performed.On the 9 th day,rotation of the shoulder was per formed.On the 10th,rope drawing movement was performed com bining the upmentioned exercises.On the 14th,the patients could have exercises,in groups.In order to obtain satisfied effect,each must performed the exercises according to the operation and postoperative time of her own.The functions of up-lifting,abduction,adduction,intorsion,and extorsion were detected and recorded for 3 times i.e.before operation,the 8t day after operation,and before discharge.Result:After functional exercieses,reexamination(1-2 months later)showed that 33 of the 38 patients(86%)had the same functions of up-lifting,abduction,supination,and pronation as that before operation or of the healthy side.5 cases had less extorsion of 20-30 degrees,counted for 9%.2 cases had too late movement because of lymph vessel injury during operation and the edema persisted for 3 years.Conclusion:The new concept of early carcinoma must be set up,susceptible factors and the knowledge of mamman hygiene must be grasped in order to prevent mastocarcinoma and improve the quality of the patients‘ life.The patients‘ limb function exercises should be guided corectly.     

乳腺癌术后上肢功能的康复训练

Background:The aim of treatment of mastocarcinoma is to lengthen the lifetime of the patients,and improve their quality of life.Function training is very important in postoperative rehabilitation treatment for the mastocarcinoma patients.The degree that functions recover shows direct proportion to the rehabilitation training.     

Evaluation of a new rehabilitation program for postoperative patients with breast cancer

The purpose of the present study was to evaluate the efficacy of a newly designed rehabilitation program for postoperative patients with breast cancer. This was achieved through examinations to clarify the range of motion (ROM) of the shoulder joint, postoperative pain and recovery of activities of daily living (ADL). The ROM of the shoulder joint was evaluated with respect to five items and determinations were carried out five times. Patients were orally questioned four times regarding their pain after surgery, movement-associated chest pain, pain at night and operative wound pain. Evaluation of the ADL after discharge was conducted using a three-level rating method at postoperative week 4 and week 12. A total of 72 patients were studied, comprising 39 who underwent pectoral muscle-conserving mastectomy and 33 who underwent breast-conserving surgery. The arm movement of forward raising showed the greatest decline, followed by lateral raising of the arm. Postoperative time-course changes in internal/external arm rotation, as well as backward arm raising were slight. Comparison of the operative procedures revealed differences only for lateral arm raising at postoperative week 4, while there were no differences in any of the shoulder joint movements. Lowering of the ROM of the shoulder joint was more marked at an earlier time (week 1 to week 2) after surgery, but it was not statistically significant. Pain at night and operative wound pain were prolonged over the period, and reported in postoperative week 1 to week 12 by 3-15% of patients. All ADL items became almost normal in approximately 90% of patients at postoperative week 4. The efficacy of the present rehabilitation program early after surgery was demonstrated in terms of recovery of ADL as well as the ROM of the arm on the affected side.