乳腺癌术后肩关节活动度分析

doi:10.3969/j.issn.1006-9771.2025.03.013

摘要/Abstract

摘要：

目的观察乳腺癌行腋窝淋巴结清扫术后放疗前手术侧肩关节活动度的特点。

方法回顾性分析2022年1月至2023年12月河北医科大学第四医院女性单侧乳腺癌行腋窝淋巴结清扫术后化疗患者185例。收集患者一般资料，采用量角器评估手术侧肩关节活动度，采用水体积置换方法评估手术侧淋巴水肿程度，采用疼痛强度简易描述量表(VRS)评定手术侧上肢疼痛。

结果手术侧肩关节前屈和外展角度分别为(158.90±17.17)°和(147.70±24.59)°。不同年龄、有无淋巴水肿患者间，手术侧肩关节前屈、外展角度存在显著性差异(t > 2.925, P < 0.05)。线性多因素回归结果显示，年龄≥ 55岁(β = -7.766, 95%CI -13.161~-2.360, P = 0.005)、有淋巴水肿(β = -10.991, 95%CI -19.063~-2.925, P = 0.008)患者手术侧肩关节前屈角度较小；术后时间增加(β = 0.463, 95%CI 0.012~0.924, P = 0.049)、BMI 24~27.9 kg/m² (β = 6.211, 95%CI 0.660~11.761, P = 0.030)(与BMI < 24 kg/m²比较)患者手术侧肩关节前屈角度较大。年龄≥ 55岁(β = -10.047, 95%CI -17.358~-2.747, P = 0.008)、有淋巴水肿(β = -14.171, 95%CI -25.191~-3.150, P = 0.013)患者手术侧肩关节外展角度较小。

结论乳腺癌腋窝淋巴结清扫术后早期患者手术侧肩关节前屈、外展活动度减小，与年龄和淋巴水肿有关。

关键词: 乳腺癌, 肩关节, 上肢, 关节活动度

Abstract:

Objective To observe the characteristics of affected shoulder joint range of motion in patients with breast cancer after axillary lymph node dissection before radiotherapy.

Methods From January, 2022 to December, 2023, 185 female patients from the Fourth Hospital of Hebei Medical University after unilateral breast cancer who underwent axillary lymph node dissection were reviewed. Their general data were collected; affected shoulder joint range of motion was evaluated by progoniometer; lymphedema of affected upper extremities was evaluated by water volume replacement; Verbal Rating Scale (VRS) was used to evaluate the pain in the upper extremity of the operative side.

Results The angles of anterior flexion and abduction of the affected shoulder joint were (158.90±17.17)° and (147.70±24.59)°. There were significant differences in the angles of affected shoulder anterior flexion and abduction among patients at different ages (more than 55 years and less than 55 years) and those with or without lymphedema. Multiple linear regression showed that the angle of affected shoulder flexion was smaller in patients aged more than 55 years (β= -7.766, 95%CI -13.161 to -2.360, P= 0.005), and with lymphedema (β= -10.991, 95%CI -19.063 to -2.925, P= 0.008); was larger in patients with longer duration after operation (β= 0.463, 95%CI 0.012 to 0.924, P= 0.049), and BMI 24 to 27.9 kg/m² (β= 6.211, 95%CI 0.660 to 11.761, P= 0.030) (compared with BMI < 24 kg/m²). The angle of affected shoulder abduction was smaller in patients aged more than 55 years (β= -10.047, 95%CI -17.358 to -2.747, P= 0.008), and with lymphedema (β= -14.171, 95%CI -25.191 to -3.150, P= 0.013).

Conclusion Shoulder joint range of motion has reduced in flexion and abduction in patients at early stage after axillary lymph node dissection for breast cancer, which is related to age and lymphedema.

Key words: breast cancer, shoulder joint, upper extremity, range of motion

中图分类号:

R737.9

耿文慧, 周严红, 尹俊普, 韩磊, 高阳. 乳腺癌术后肩关节活动度分析[J]. 《中国康复理论与实践》, 2025, 31(3): 356-364.

GENG Wenhui, ZHOU Yanhong, YIN Junpu, HAN Lei, GAO Yang. Shoulder joint range of motion after operation for breast cancer[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(3): 356-364.

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自变量	肩关节前屈角度/°	t/F值	P值
年龄		2.925	0.004
< 55岁	161.85±16.07
≥ 55岁	154.46±17.91
BMI		2.981	0.053
< 24 kg/m²	155.58±16.21
24~27.9 kg/m²	162.28±16.88
≥ 28 kg/m²	157.16±18.19
文化程度		0.664	0.575
小学及以下	155.69±18.68
初中	158.73±17.00
高中	160.91±15.56
大学及以上	160.00±18.09
肿瘤位置		0.824	0.411
左	158.52±17.34
右	160.78±16.12
肿瘤象限		1.253	0.290
外上	157.88±17.61
外下	160.12±16.22
内上	164.77±14.01
内下	152.08±21.69
中央区	158.17±16.95
手术类型		0.908	0.365
保乳术	161.50±14.57
乳房切除术	158.39±17.63
化疗类型		2.067	0.040
新辅助	157.88±17.06
辅助	166.67±17.57
肿瘤分期		0.296	0.744
Ⅱ期	158.75±18.53
Ⅲ期	159.18±17.06
Ⅳ期	154.38±13.74
疼痛		1.548	0.216
无疼痛	160.18±17.09
轻度疼痛	155.32±17.21
中度疼痛	150.00±0.00
淋巴水肿		2.936	0.004
无	160.12±16.73
有	148.16±17.65
腋窝淋巴结清扫个数		0.607	0.544
< 15个	158.15±18.61
≥ 15个	159.68±15.52

自变量	肩关节外展角度/°	t/F值	P值
年龄		3.156	0.002
< 55岁	152.25±23.51
≥ 55岁	140.88±24.76
BMI		2.480	0.087
< 24 kg/m²	143.92±24.24
24~27.9 kg/m²	152.22±24.63
≥ 28 kg/m²	144.54±24.18
文化程度		1.275	0.285
小学及以下	141.11±25.38
初中	147.75±24.64
高中	150.11±21.63
大学及以上	151.47±26.41
肿瘤位置		0.787	0.433
左	146.51±24.09
右	149.41±25.36
肿瘤象限		0.705	0.589
外上	146.96±24.82
外下	148.90±25.21
内上	153.41±20.90
内下	139.17±27.46
中央区	146.33±25.94
手术类型		1.332	0.184
保乳术	153.17±21.99
乳房切除术	146.65±24.99
化疗类型		1.285	0.200
新辅助	146.60±23.98
辅助	154.44±29.80
肿瘤分期		1.014	0.365
Ⅱ期	150.97±25.07
Ⅲ期	147.44±24.61
Ⅳ期	137.50±24.59
疼痛		1.630	0.199
无疼痛	149.60±23.51
轻度疼痛	142.13±27.26
中度疼痛	150.00±0.00
淋巴水肿		3.139	0.002
无	149.58±24.47
有	131.32±19.50
腋窝淋巴结清扫个数		0.730	0.466
< 15个	146.40±25.32
≥ 15个	149.04±23.58

自变量	模型Ⅰ		模型Ⅱ		模型Ⅲ
自变量	β(95%CI)	P值	β(95%CI)	P值	β(95%CI)	P值
年龄(< 55岁)
≥ 55岁	-7.387 (-12.370~-2.404)	0.004	-7.301 (-12.691~-1.912)	0.009	-7.766 (-13.161~-2.360)	0.005
BMI(< 24 kg/m²)
24~27.9 kg/m²	6.701 (0.991~12.410)	0.022	6.847 (1.378~12.315)	0.014	6.211 (0.660~11.761)	0.030
≥ 28 kg/m²	1.576 (-5.037~8.229)	0.641	3.144 (-3.321~9.608)	0.339	1.774 (-4.861~8.410)	0.601
淋巴水肿(无)
有	-11.963 (-20.003~-3.923)	0.004	-11.965 (-19.952~-3.988)	0.004	-10.991 (-19.063~-2.925)	0.008
手术方式(乳房切除)
保乳术	4.060 (-2.361~10.481)	0.214	1.748 (-4.585~8.082)	0.587	2.124 (-4.340~8.369)	0.517
文化程度(小学及以下)
初中	3.038 (-3.913~9.989)	0.390	-0.14 (-6.961~6.730)	0.968	0.03 (-6.817~6.3977)	0.993
高中	5.215 (-2.420~12.850)	0.179	2.493 (-4.840~9.836)	0.506	2.621 (-4.774~10.027)	0.488
大学及以上	4.306 (-3.819~12.430)	0.297	-0.095 (-8.328~8.137)	0.982	-0.221 (-8.398~7.956)	0.958
疼痛(无疼痛)
轻度疼痛	4.804 (-0.904~10.511)	0.099	3.257 (-2.440~8.955)	0.261	3.897 (-1.820~9.615)	0.180
中度疼痛	12.463 (-11.563~36.490)	0.307	11.282 (-12.361~34.925)	0.348	6.194 (-17.582~29.971)	0.608
术后每增加10 d	0.381 (-0.082~0.845)	0.106	0.436 (-0.009~0.880)	0.055	0.463 (0.012~0.924)	0.049
腋窝清扫淋巴结个数	-0.062 (-0.456~0.331)	0.755	-0.034 (-0.415~0.346)	0.858	-0.022 (-0.406~0.362)	0.909

自变量	模型Ⅰ		模型Ⅱ		模型Ⅲ
自变量	β(95%CI)	P值	β(95%CI)	P值	β(95%CI)	P值
年龄(< 55岁)
≥ 55岁	-11.374 (-18.485~-4.263)	0.002	-11.696 (-18.572~-4.820)	0.001	-10.047 (-17.358~-2.747)	0.008
BMI(< 24 kg/m²)
24~27.9 kg/m²	8.306 (0.106~16.505)	0.047	8.528 (0.725~16.330)	0.032	7.729 (-0.148~15.607)	0.054
≥ 28 kg/m²	0.629 (-8.926~10.184)	0.897	2.993 (-6.231~12.216)	0.523	2.229 (-7.169~11.626)	0.640
淋巴水肿(无)
有	-14.263 (-29.742~-6.783)	0.002	-14.301 (-29.597~-7.005)	0.002	-14.171 (-25.191~-3.150)	0.013
手术方式(乳房切除)
保乳术	8.220 (-0.939~17.378)	0.078	4.881 (-4.135~13.896)	0.287	4.543 (-4.525~13.611)	0.324
文化程度(小学及以下)
初中	6.635 (-3.272~16.542)	0.188	1.997 (-7.800~11.794)	0.688	1.752 (-8.018~11.523)	0.724
高中	9.003 (-1.879~19.884)	0.104	4.990 (-5.538~15.519)	0.351	5.889 (-4.650~16.428)	0.272
大学及以上	10.359 (-1.220~21.939)	0.079	3.935 (-7.805~15.675)	0.509	3.618 (-8.093~15.329)	0.543
疼痛(无疼痛)
轻度疼痛	1.018 (-7.220~9.257)	0.808	-1.819 (-9.884~6.246)	0.657	-0.493 (-8.525~7.540)	0.904
中度疼痛	15.221 (-19.459~49.900)	0.388	13.474 (-19.993~46.941)	0.428	8.190 (-25.212~41.593)	0.629
术后每增加10 d	0.010 (-0.065~0.674)	0.997	0.089 (-0.546~0.724)	0.782	0.136 (-0.507~0.779)	0.677
腋窝清扫淋巴结个数	-0.035 (-0.597~0.528)	0.903	0.023 (-0.520~0.565)	0.934	0.064 (-0.482~0.611)	0.817