中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2025, Vol. 23 ›› Issue (4): 369-376.doi: 10.19438/j.cjoms.2025.04.009

• 论著 • 上一篇    下一篇

基于四维度创新模型的“互联网+”远程康复对口腔癌择区颈淋巴结清扫术后患者肩颈康复的效果评价

王佳1,2, 李怡君3, 张序杰2, 刘法昱2, 孙长伏2, 戴红良1   

  1. 1.锦州医科大学护理学院,辽宁 锦州 121001;
    2.中国医科大学口腔医学院·附属口腔医院 口腔颌面外科,辽宁 沈阳 110002;
    3.中国医科大学附属第一医院,辽宁 沈阳 110801
  • 收稿日期:2025-03-24 修回日期:2025-04-14 出版日期:2025-07-20 发布日期:2025-08-04
  • 通讯作者: 戴红良,E-mail: daihongliang@jzmu.edu.cn
  • 作者简介:王佳（1983-）,女,在读硕士研究生,E-mail: 18040229069m@sina.cn
  • 基金资助:
    辽宁省应用基础研究计划项目（2023JH2/101300029）

Research on the effectiveness of "Internet +" remote rehabilitation based on a four-dimensional innovation model for shoulder and neck recovery in oral cancer patients after selective neck dissection

Wang Jia1, 2, Li Yijun3, Zhang Xujie2, Liu Fayu2, Sun Changfu2, Dai Hongliang1   

  1. 1. School of Nursing, Jinzhou Medical University. Jinzhou 121001;
    2. Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University; Liaoning Provincial Key Laboratory of Oral Diseases. Shenyang 110002;
    3. The First Hospital of China Medical University. Shenyang 110801, Liaoning Province, China
  • Received:2025-03-24 Revised:2025-04-14 Online:2025-07-20 Published:2025-08-04

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摘要： 目的：评价基于四维度创新模型的“互联网+”远程康复模式对口腔癌择区颈淋巴结清扫术后患者肩颈功能康复的效果。方法：选择2024年7月—10月于中国医科大学附属口腔医院接受口腔癌手术的患者61例,采用随机数字表法分为对照组（n=31）与试验组（n=30）。对照组接受标准术后康复锻炼,通过使用宣传手册和康复锻炼视频,指导患者出院后进行正确的康复训练以及注意事项。患者复诊时,康复医师对康复效果进行评估,并提供指导意见。试验组在出院后实施基于四维度创新模型的“互联网+”远程康复,内容包括指导患者下载康复随访APP软件,APP软件每天提示患者进行功能锻炼,患者完成康复锻炼后进行打卡,并定期提示患者录制康复锻炼视频。康复医师根据患者录制的锻炼视频,远程对其康复效果进行评价和指导。应用肩关节Constant-Murley评分量表、肩关节疼痛和功能障碍指数量表（SPADI）以及颈淋巴清扫损伤指数量表（NDII）,比较两组术前及术后10 d、1个月、3个月的肩颈功能状况。结果：术前两组患者基本资料无统计学差异（P>0.05）。广义估计方程分析显示,在NDII量表中,组间效应检验表明,两组患者颈部功能存在统计学差异（P<0.05）,其中术后3个月时试验组评分显著高于对照组（P<0.05）,而术后10 d和1个月时两组无统计学差异。在SPADI量表中,组间效应检验显示两组肩关节功能障碍评分有统计学差异（P<0.05）;不同时间点比较发现,术后1个月时试验组评分显著高于对照组（P<0.05）,但术后10 d和3个月时两组无统计学差异。疼痛评分方面,无论是组间比较还是不同时间点比较,均无统计学差异（P>0.05）。Constant-Murley评分量表显示,在总分、日常活动能力、肩关节活动范围和肌力评分方面,组间效应检验显示,试验组评分显著高于对照组（P<0.05）,其中术后1个月时各项评分试验组均显著高于对照组（P<0.05）;而术后10 d和3个月,两组无统计学差异,量表中的疼痛评分组间和时间点比较均无统计学差异（P>0.05）。结论：相比传统康复方式,运用基于四维度创新模型的“互联网+”远程康复,能够使口腔癌择区颈淋巴结清扫术后患者肩功能在术后1个月得到明显改善,颈部功能在术后3个月得到明显改善,同时能够提高患者康复效率,提升生活质量。

关键词: 口腔癌, 互联网+, 远程康复, 肩颈功能训练, 四维度创新模型

Abstract: PURPOSE: To evaluate the improvement of shoulder and neck function in postoperative oral cancer patients using an "Internet +" remote rehabilitation model based on a four-dimensional innovation model. METHODS: A total of 61 patients who underwent oral cancer surgery in Hospital of Stomatology, China Medical University from July to October 2024 were selected and divided into control group (n=31) and experimental group (n=30) by random number table method. The control group received standard postoperative rehabilitation, including instructional manuals and exercise videos, to ensure proper rehabilitation training and precautions after discharge. Rehabilitation physicians assessed outcomes and provided guidance during follow-up visits. The experimental group adopted the "Internet +" remote rehabilitation model based on a four-dimensional innovation framework. The patients were instructed to download a rehabilitation follow-up app, which provided daily exercise reminders. Patients logged their completed exercises and periodically recorded rehabilitation videos. Rehabilitation physicians remotely evaluated and guided patients based on the submitted videos. Shoulder and neck function were assessed using the Constant-Murley Shoulder Score, Shoulder Pain and Disability Index (SPADI), and Neck Dissection Impairment Index(NDII) at preoperative, 10-day, 1-month, and 3-month postoperative intervals. RESULTS: There was no significant differences in baseline characteristics between the two groups(P>0.05). Generalized estimating equation analysis showed that there was significant difference in neck function between the two groups in the NDII scale (P<0.05). The score of the experimental group was significantly higher than that of the control group at 3 months after surgery(P<0.05), but there was no significant difference between the two groups at 10 days and 1 month after surgery. For SPADI, between-group differences were observed in shoulder dysfunction (P<0.05), with the experimental group showing higher scores at 1 month (P<0.05), but no significant differences at 10 days or 3 months. Pain scores did not differ between groups or across time points (P>0.05). Additionally, Constant-Murley Score demonstrated that the experimental group had higher total scores, daily activity function, range of motion, and strength (P<0.05), with all subscales significantly higher at 1 month (P<0.05), but no differences at 10 days or 3 months. Similarly, pain scores in this scale showed no significant differences(P>0.05). CONCLUSIONS: Compared with traditional rehabilitation methods, the application of "Internet +" remote rehabilitation based on the four-dimensional innovative model can significantly improve the shoulder function of patients after selective neck dissection for oral cancer 1 month after operation, and neck function 3 months after operation. At the same time, it can accelerate the rehabilitation efficiency of patients and improve their quality of life.

Key words: Oral cancer, Internet +, Remote rehabilitation, Shoulder and neck function training, Four-dimensional innovation model

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