头颈癌成人功能性后遗症的康复与物理治疗：系统综述与荟萃分析

文献信息

中文摘要

背景与目的： 头颈癌（HNC）治疗后的功能性后遗症常损害吞咽、张口、言语、颈肩活动度及整体生活质量。尽管康复日益被视为多学科护理的重要组成部分，但证据大多集中于孤立的功能障碍，而非对康复领域进行全面评估。旨在系统评价康复与物理治疗干预对预防和治疗头颈癌成人功能性后遗症的有效性。材料与方法：根据PRISMA 2020指南，对随机对照试验进行了系统综述与荟萃分析。检索了PubMed/MEDLINE、Embase、Cochrane Library和PEDro，从建库至2026年6月。纳入接受保守康复干预的成年头颈癌患者的研究。对张口和牙关紧闭领域内临床同质的干预对比进行了随机效应荟萃分析。涉及干预时机、额外治疗成分或实施策略的不同比较分别进行分析。结果：纳入27篇文献，代表21项独立随机试验。定量合成仅限于临床同质的干预对比。与常规护理相比，预防性下颌康复在三项独立试验中有利于更大的张口度（平均差 = 2.85 mm；常规95% CI：0.38-5.32），尽管改良Hartung-Knapp敏感性区间包括无效（95% CI：-2.58-8.27）。三项独立试验中牙关紧闭的合并估计也支持康复，但常规和小样本校正置信区间均包括无效（RR = 0.87；常规95% CI：0.53-1.42；改良Hartung-Knapp 95% CI：0.25-2.98）。口腔癌手术和游离皮瓣重建后的术后吞咽康复在两个序贯队列中均支持康复（变化调整差 = 10.06分；95% CI：7.68-12.44；GEE组×时间β = 7.29分；95% CI：4.11-10.47）。额外的时机、支持、增强和实施比较分别进行了分析。结论：针对性康复干预对头颈癌成人的下颌活动度和术后吞咽功能产生了有利估计。预防性下颌康复有利于更大的张口度，尽管小样本调整后结果不确定；牙关紧闭估计也支持康复，但仍不精确。

英文摘要

Background and Objectives: Functional sequelae following head and neck cancer (HNC) treatment frequently impair swallowing, mouth opening, speech, cervical and shoulder mobility, and overall quality of life. Although rehabilitation is increasingly recognized as an essential component of multidisciplinary care, evidence has largely focused on isolated functional impairments rather than providing a comprehensive evaluation across rehabilitation domains. To systematically evaluate the effectiveness of rehabilitation and physiotherapy interventions for preventing and treating functional sequelae in adults with head and neck cancer. Materials and Methods: A systematic review and meta-analysis of randomized controlled trials was conducted according to PRISMA 2020 guidelines. PubMed/MEDLINE, Embase, Cochrane Library, and PEDro were searched from inception to June 2026. Studies involving adult patients with head and neck cancer receiving conservative rehabilitation interventions were included. Random-effects meta-analyses were performed for clinically homogeneous intervention contrasts within the mouth-opening and trismus domains. Distinct comparisons involving intervention timing, additional therapeutic components, or delivery strategies were analysed separately. Results: Twenty-seven publications representing 21 independent randomized trials were included. Quantitative synthesis was restricted to clinically homogeneous intervention contrasts. Compared with usual care, preventive jaw rehabilitation favoured greater mouth opening across three independent trials (mean difference = 2.85 mm; conventional 95% CI: 0.38-5.32), although the modified Hartung-Knapp sensitivity interval included no effect (95% CI: -2.58-8.27). The pooled estimate for trismus across three independent trials also favoured rehabilitation, although both conventional and small-sample-adjusted confidence intervals included no effect (RR = 0.87; conventional 95% CI: 0.53-1.42; modified Hartung-Knapp 95% CI: 0.25-2.98). Postoperative swallowing rehabilitation after oral-cancer surgery and free-flap reconstruction favoured rehabilitation in both sequential cohorts (adjusted difference in change = 10.06 points; 95% CI: 7.68-12.44; GEE group-by-time β = 7.29 points; 95% CI: 4.11-10.47). Additional timing, support, enhancement, and delivery comparisons were analysed separately. Conclusions: Targeted rehabilitation interventions produced favourable estimates for mandibular mobility and postoperative swallowing function in adults with head and neck cancer. Preventive jaw rehabilitation favoured greater mouth opening, although the result was inconclusive after small-sample adjustment; the trismus estimate also favoured rehabilitation but remained imprecise.