目的：本研究旨在探討物理治療於乳癌病人術後肩關節活動障礙之療效及其影響因素。方法：採單一樣本重複測量病歷回溯性之研究設計。研究對象為南部某區域教學醫院之2008年5月至2010年4月術前無手臂神經受損及肩關節活動障礙，術後無手臂神經受損、旋轉肌肌腱撕裂傷及中風症狀之21位單側乳癌術後門診病人。採Friedman檢定、Wilcoxon符號等級檢定與Spearman等級相關檢定等無母數統計方法進行資料分析。結果：物理治療對乳癌術後肩關節活動障礙改善具有顯著療效，肩關節活動療效除內轉外，其餘活動療效與術後物理治療介入時間呈現負相關(Spearman’s rho= - .748 ~ - .444，p<.05)，而病人年齡與物理治療療效無顯著的相關性(p>.05)。肩關節前屈與外展角度隨著療程次數增加而增加，治療到第4次分別可比治療前角度增加40.3%與45.2%。肩關節肌力於物理治療第1次療程後有顯著改善(p<.05)，後續療程之改善並無顯著增加(p>.05)。肩關節活動角度與肌力之各療程之療效，彼此之間有顯著的正相關(Spearman’s rho= .558 ~ .999，p<.01)。結論：物理治療早期介入且持續性施予有助於乳癌病人術後肩關節活動障礙之改善。 Objectives: The aim of this retrospective study was to investigate the effectiveness of physiotherapy treatment of shoulder function in patients who have undergone breast cancer surgery and axillary lymph node dissection and its determinants. Methods: The study adopted a one-group repeated-measures design involving twenty-one patients without brachial plexus injury, rotator cuff tear and stroke following surgical treatment of breast cancer. Patients with unilateral breast cancer were selected from physiotherapy outpatients during the period May 2008 through April 2010 in a regional hospital in Southern Taiwan. Nonparametric statistics were used for data analysis. Results: Shoulder function showed a significant improvement in mobility and had significantly restored muscular deficits in strength after physiotherapy treatment. The improvement except on internal rotation was negatively related to the interval from surgery to physiotherapy initiation (Spearman’s rho = -.748 ~ -.444, p<.05), yet not related to age. Both flexion and abduction had increased significantly with increasing treatment frequencies, an increase of 40.3% and 45.2% compared to the treatment before, respectively. Muscle strength was significantly recovered at the first treatment session (p<.05), but further improvement was not notified subsequently. The correlation matrix of the improvement on each treatment session respect to the range of different shoulder movement showed a positive correlation between each other (Spearman’s rho = .558 ~ .999, p<.01). Conclusions: Range of shoulder movement of patients with breast cancer surgery and axillary lymph node dissection can be improved with early and constant physiotherapy.
