CAJ | 학술논문

　　目的探讨颈清扫术中颈丛神经深支保留对术后肩功能的影响。方法37例头颈部恶性肿瘤患者接受不同颈清扫术式，17例保留副神经及颈丛C2-C4深支（A组），11例切除副神经、保留颈丛C2-C4深支（B组），9例切除副神经及颈丛C2-C4深支（C组）。术后6个月就肩关节功能障碍指数(SPADI)、肩关节活动度进行比较，术后6周及6个月就斜方肌肌电图进行比较。结果 SPADI及肩关节活动度A组恢复最好，B组次之，C组最差，三组间两两比较均有统计学差异。术后6周A组斜方肌三部分肌电活动均较强，B组上部活动较强，与A组比较无明显差异，中、下部较A组差；术后6月A组斜方肌三部分肌电均优于B组，C组术后6周及6月均未引出肌电活动。结论颈清扫术中酌情保留颈丛神经深支，可以减少传统手术后肩功能障碍发生的机率和程度，提高患者术后生活质量。
　　목적탐토경청소술중경총신경심지보류대술후견공능적영향。방법37례두경부악성종류환자접수불동경청소술식，17례보류부신경급경총C2-C4심지（A조），11례절제부신경、보류경총C2-C4심지（B조），9례절제부신경급경총C2-C4심지（C조）。술후6개월취견관절공능장애지수(SPADI)、견관절활동도진행비교，술후6주급6개월취사방기기전도진행비교。결과 SPADI급견관절활동도A조회복최호，B조차지，C조최차，삼조간량량비교균유통계학차이。술후6주A조사방기삼부분기전활동균교강，B조상부활동교강，여A조비교무명현차이，중、하부교A조차；술후6월A조사방기삼부분기전균우우B조，C조술후6주급6월균미인출기전활동。결론경청소술중작정보류경총신경심지，가이감소전통수술후견공능장애발생적궤솔화정도，제고환자술후생활질량。
Objective To investigate the relation during preservation of the deep branch of the cervical plexus and shoulder function after neck dissection. Methods Thirty seven patients who had undergone different neck dissections were enrolled and divided into 3 groups. Seventeen patients preserved both accessory nerve and the cervical branches, 11 preserved cervical branches, and 9 sacrificed both of them. Shoulder pain and disability scores (SPADI) and Goniometric measurements were detected at the sixth postoperative month. The distal motor latency of the nerve with sEMG to detect electromyographic activity of the trapezius muscle was conducted at the sixth week and sixth month postoperatively among the three groups. Results The patients in group A whose accessory nerves and cervical branches were preserved had a significant functional rehabilitation of the shoulder, while those who preserved only the cervical branches in group B had a better result than the radical neck dissection in group C after 6 months of operation. Conclusion Preservation of the branches from C2-C4 of the cervical plexus to trapezius muscle during neck dissection can reduce the probability of occurrence and extent of shoulder dysfunction and improve the postoperative quality of life.