宋健;彭理;邓明;刘淑芬;刘颖;
SONG Jian;PENG Li;DENG Ming;LIU Shufen;LIU Ying;Department of Rehabilitation Medicine,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Office for Cancer Diagnosis and Treatment Quality Control,Cancer Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

• 1:中国医学科学院北京协和医院康复医学科
• 2:中国医学科学院北京协和医院乳腺外科
• 3:中国医学科学院肿瘤医院癌症诊治质控办公室

摘要(Abstract)：

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比(2823.58±537.60)cm³,P=0.006]、治疗结束后3个月[(2492.91±446.52)cm3,P=0.006]、治疗结束后3个月[(2492.91±446.52)cm³比(2813.90±533.87)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,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。
Objective To explore the effect of myofascial release technique in the treatment of stage Ⅲlymphedema 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(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。
Objective To explore the effect of myofascial release technique in the treatment of stage Ⅲlymphedema 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 vs.(2823.58±537.60)cm³, P=0.006] and 3 months after treatment[(2492.91±446.52)cm3, P=0.006] and 3 months after treatment[(2492.91±446.52)cm³ vs.(2813.90±533.87)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, 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. ConclusionsMyofascial 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.

关键词(KeyWords)： 乳腺癌;淋巴水肿;肌筋膜松解手法;康复治疗
breast cancer;lymphedema;myofascial release;rehabilitation treatment

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 宋健;彭理;邓明;刘淑芬;刘颖;
SONG Jian;PENG Li;DENG Ming;LIU Shufen;LIU Ying;Department of Rehabilitation Medicine,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Breast Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Office for Cancer Diagnosis and Treatment Quality Control,Cancer Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

参考文献(References)：

• [1] Ullah MF.Breast Cancer:Current Perspectives on the Disease Status[J].Adv Exp Med Biol,2019,1152:51- 64.
• [2] Peart O.Breast intervention and breast cancer treatment options[J].Radiol Technol,2015,86:535- 558.
• [3] Shao Y,Zhong DS.Manual lymphatic drainage for breast cancer- related lymphoedema[J].Euro J Cancer Care,2017,26:e12517.
• [4] Kataru RP,Wiser I,Baik JE,et al.Fibrosis and secondary lymphedema:chicken or egg?[J].Transl Res,2019,209:68- 76.
• [5] Leung N,Furniss D,Giele H.Modern surgical management of breast cancer therapy related upper limb and breast lymphoedema[J].Maturitas,2015,80:384- 390.
• [6] Ezzo J,Manheimer E,McNeely ML,et al.Manual lymph-tic drainage for lymphedema following breast cancer treatment[J].Cochrane Database Syst Rev,2015(5):CD003475.
• [7] Laimi K,M?kil? A,B?rlund E,et al.Effectiveness of myofascial release in treatment of chronic musculoskeletal pain:a systematic review[J].Clin Rehabil,2018,32:440- 450.
• [8] Groef AD,Kampen MV,Verlvoesem N,et al.Effect of myofascial techniques for treatment of upper limb dysfunc-tions in breast cancer survivors:randomized controlled trial[J].Support Care Cancer,2017,25:2119- 2127.
• [9] Hutchison NA.Diagnosis and Treatment of Edema and Lymphedema in the Cancer Patient[J].Rehabil Nurs J,2018,43:229- 242.
• [10] Myers T,Earls J.Fascial release for structural balance[M].North Atlantic Books,2017.
• [11] Chiarotto A,Maxwell LJ,Ostelo RW,et al.Measurement properties of visual analogue scale,numeric rating scale,and pain severity subscale of the brief pain inventory in patients with low back pain:a systematic review[J].J Pain,2019,20:245- 263.
• [12] Wittlinger H,Wittlinger D,Wittlinger.Dr.Vodder's Manual Lymph Drainage:A Practical Guide[M].Heidelberg:Hang Publishers,2010.
• [13] 廖春丽，王聪，周欣，等.DASH简式评分表中文版应用于乳腺癌病人上肢功能障碍评价研究的信效度检验[J].护理研究，2014,28:3- 7.
• [14] Aoishi Y,Oura S,Nishiguchi H,et al.Risk factors for breast cancer-related lymphedema:correlation with docetaxel administration[J].Breast cancer,2020,27:929- 937.
• [15] 詹丽倩，李巍伟，许梦雅.“8”字弹力绷带加压包扎法治疗乳腺癌术后上肢淋巴水肿的疗效观察[J].中国老年保健医学，2022,20:118- 121.
• [16] 梁欣，荆海红.等速肌力训练对乳腺癌改良根治术后上肢淋巴水肿患者患肢肌力及运动功能的影响[J].中国疗养医学，2021,30:966- 968.
• [17] Grieve R,Clark J,Pearson E,et al.The immediate effect of soleus trigger point pressure release on restricted ankle joint dorsiflexion:A pilot randomised controlled trial[J].J Bodyw Mov Ther,2011,15:42- 49.
• [18] Hains G,Descarreaux M,Hains F.Chronic shoulder pain of myofascial origin:a randomized clinical trial using ischemic compression therapy[J].J Manipulative Physiol Ther,2010,33:362- 369.
• [19] Ajimsha MS,Al- Mudahka NR,Al- Madzhar JA.Effective-ness of myofascial release:Systematic review of randomized controlled trials[J].J Bodyw Mov Ther,2015,19:102- 112.
• [20] Kim G,Donohoe K,Smith MP,et al.Use of non- contrast MR in diagnosing secondary lymphedema of the upper extremities[J].Clin Imaging,2021,80:400- 405.
• [21] Yusof KM,Avery- Kiejda KA,Ahmad Suhaimi S,et al.Assessment of Potential Risk Factors and Skin Ultrasound Presentation Associated with Breast Cancer- Related Lymphedema in Long- Term Breast Cancer Survivors[J].Diagnostics (Basel),2021,11:1303.
• [22] Zullo A,Fleckenstein J,Schleip R,et al.Structural and functional changes in the coupling of fascial tissue,skeletal muscle,and nerves during aging[J].Front Physiol,2020,11:592.
• [23] Guliyeva G,Huayllani MT,Boczar D,et al.Correlation of older age with severity of lymphedema in breast cancer survivors:A systematic review[J].Breast Dis,2021,40:191- 197.