下颌骨重建术后患者咀嚼功能康复方案的构建及初步应用

doi:10.19439/j.sjos.2026.02.017

摘要/Abstract

摘要： 目的:构建下颌骨重建术后患者咀嚼功能康复方案,评价其初步应用效果。方法:以复杂干预框架、癌症症状自理理论为基础,通过文献回顾,运用半结构式访谈,总结21例下颌骨重建术后患者咀嚼功能康复现状及需求,形成干预方案初稿,遴选12名相关领域专家进行论证并修改后,形成康复方案终稿。通过目的抽样法,选取2024年3—6月在上海交通大学医学院附属第九人民医院行义齿修复的下颌骨重建术后患者16例为研究对象,运用随机数字表法分为试验组和对照组,每组各8例。试验组在常规护理基础上,实施咀嚼功能康复方案;对照组接受常规护理。干预1、3、6个月后,比较两组咀嚼能力、下颌骨功能限制量表（Jaw Functional Limitation Scale,JFLS）及Sato调查问卷评分。结果:共进行1轮专家论证,有效问卷回收率为100%,专家权威系数为0.908。下颌骨重建术后患者咀嚼功能康复方案包括自我调节技能/能力、自我效能两个维度以及目标设定、自我监控、反应性思考/决策、行动、症状评估、反应管理、适时鼓励、定时评估患者心理因素和定时评估家属共9个条目及具体内容。方案初步应用结果显示,两组不同时间点JFLS评分组间效应均有统计学意义（P<0.05）。简单效应分析结果显示,干预前、干预后1个月、干预后3个月,两组咀嚼能力测试评分无统计学差异（P>0.05）;干预后6个月,试验组评分显著高于对照组（P=0.001）。干预前、干预后1个月,两组JFLS评分比较无显著差异（P>0.05）;干预后3个月,试验组评分显著高于对照组（P<0.05）。在3个时间点,两组Sato调查问卷评分相比均无显著差异（P>0.05）。结论:本研究构建的下颌骨重建术后患者咀嚼功能康复方案内容全面,具有一定科学性和可行性。实施该方案有助于下颌骨重建术后患者咀嚼功能康复,提高生活质量。

关键词: 下颌骨重建术, 咀嚼功能, 康复护理, 方案构建

Abstract: PURPOSE: To construct a masticatory function rehabilitation program for patients after mandibular reconstruction, and to explore its preliminary application effect. METHODS: Based on the complex intervention framework and the theory of self-care of cancer symptoms, the current situation and needs of masticatory function rehabilitation of 21 patients after mandibular reconstruction were summarized through literature review and semi-structured interviews, the first draft of the intervention plan was formed, and 12 experts in related fields were selected for demonstration and revision to form the final draft of the rehabilitation plan. A total of 16 patients who underwent mandibular reconstruction after denture restoration in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from March to June 2024 were selected by objective sampling method. They were randomly divided into the experimental group and the control group using the random number table method, with 8 cases in each group. On the basis of routine nursing, the experimental group implemented a masticatory function rehabilitation program, while the control group received usual care. At 1 month, 3 months and 6 months of intervention, the masticatory ability test, Jaw Functional Limitation Scale (JFLS) and Sato questionnaire scores were compared between the two groups. Results: A total of 1 round of expert demonstration was conducted, and the effective questionnaire recovery rate was 100%, the expert authority coefficient was 0.908. The masticatory function rehabilitation program for patients after mandibular reconstruction included two dimensions of self-regulation skills/ability and self-efficacy, as well as goal setting, self-monitoring, reactive thinking/decision-making, action, symptom assessment, response management, timely encouragement, regular assessment of patients' psychological factors, and regular assessment of family members, totally 9 items and specific contents. The preliminary application results of the scheme showed that there were statistically significant effects between the two groups at different time points (P<0.05). The results of simple effect analysis showed that there was no significant difference in the masticatory ability test scores between the two groups before intervention, at 1 month after intervention, and at 3 months after intervention (P>0.05). After 6 months of intervention, the score of the experimental group was significantly higher than that of the control group (P=0.001). There was no significant difference in the JFLS scores between the two groups before intervention and at 1 month after intervention (P>0.05). After 3 months of intervention, the score of the experimental group was significantly higher than that of the control group (P<0.05). At the three time points, there was no significant difference in the Sato questionnaire scores between the two groups (P>0.05). CONCLUSIONS: The masticatory function rehabilitation program for patients after mandibular reconstruction constructed in this study is comprehensive, scientific and feasible. The implementation of this protocol is helpful for the rehabilitation of masticatory function and the improvement of the quality of life of patients after mandibular reconstruction.

Key words: Mandibular reconstruction, Masticatory function, Rehabilitation nursing, Program construction

中图分类号:

R782.2
R493

杜林, 张悦, 顾芬. 下颌骨重建术后患者咀嚼功能康复方案的构建及初步应用[J]. 上海口腔医学, 2026, 35(2): 212-219.

Du Lin, Zhang Yue, Gu Fen. Construction and initial application of masticatory function rehabilitation program for patients after mandibular reconstruction[J]. Shanghai Journal of Stomatology, 2026, 35(2): 212-219.

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