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目的:评价颈部肌群训练减少鼻咽癌放疗患者颈部摆位误差的效果。方法:选取并分析2021年2月至2022年10月在空军军医大学第一附属医院拟行放疗的99例鼻咽癌患者资料。所有受试者按随机数字表法1∶1的比例随机分为试验组（48例）和对照组（51例）。试验组治疗前给予颈部肌群训练；对照组常规治疗无干预。每周行锥形线束CT（CBCT）扫描，测量和分析在斜坡、第4颈椎、第7颈椎椎骨水平处的摆位误差，计算每个水平处的四维位移［左右（LR）、头脚（SI）、腹背（AP）方向，床角Rtn角度］系统误差和随机误差并计算其计划靶区（PTV）边界。对比两组在斜坡、第4颈椎、第7颈椎三个不同水平处误差的差值（左右、头脚、腹背方向）；采用Spearman相关分析各方向误差的相关性。比较两组颈椎曲度的变化、皮肤不良反应（不良事件通用术语标准3.0版）及疼痛评估（数字分级评分法）结果。定性资料的组间比较采用 χ2检验，定量资料的组间比较采用 t检验。 结果:两组患者的基线特征均衡。摆位误差比较，试验组误差小于对照组。腹背方向误差比较，斜坡水平处为（0.94±0.88）mm比（1.66±1.23）mm（ P<0.001）、第4颈椎水平处为（1.13±1.03）mm比（1.63±1.35）mm（ P<0.001）、第7颈椎水平处为（1.32±1.22）mm比（1.89±1.48）mm（ P<0.001）。头脚方向摆位误差比较，斜坡水平处为（1.14±0.87）mm比（1.22±0.95）mm（ P=0.278）、第4颈椎水平处为（1.31±0.93）mm比（1.40±1.11）mm（ P=0.272）、第7颈椎水平处为（1.39±0.95）mm比1.52±1.08）mm（ P=0.100）。两组差值比较，试验组的第4颈椎、第7颈椎水平处腹背方向的差值更小（ P=0.014、0.005）。试验组腹背方向所需的PTV边界，从斜坡水平的1.77 mm增加到第7颈椎水平的2.98 mm；对照组从斜坡水平的3.02 mm增加到第7颈椎水平的4.78 mm。相关性分析显示：第4颈椎和第7颈椎水平，头脚方向摆位误差与腹背方向摆位误差呈现中等强度负相关。两组颈椎曲度改变、皮肤不良反应及疼痛评估差异没有统计学意义。 结论:颈部肌群训练可以降低鼻咽癌放疗患者腹背方向的摆位误差和PTV边界，值得临床推广。

Objective:To evaluate the effect of neck muscle training on reducing the neck setup error during radiotherapy in patients with nasopharyngeal carcinoma.Methods:Clinical data of nasopharyngeal carcinoma patients who were treated with radiotherapy in the First Affiliated Hospital of Air Force Medical University from February 2021 to October 2022 were selected and analyzed. All subjects were randomly divided into the experimental group ( n=48) and control group ( n=51) at a ratio of 1:1 using a random number table method. In the experimental group, patients received neck muscle training prior to treatment, and those in the control group received conventional treatment without additional interventions. Cone beam computed tomography (CBCT) was performed weekly to measure and analyze the setup errors at the level of the slopes, 4th cervical vertebra (C4) and 7th cervical vertebra (C7). The four-dimensional displacement [left-right (LR), superior-inferior (SI), anterior-posterior (AP), rotation (Rtn)] systematic errors and random errors at each level were calculated, and the planning target volume (PTV) boundary was calculated. The differences at three different levels of slope, C4, C7 (LR, SI, AP axis) were compared between two groups. The correlation of setup errors in each direction was analyzed by Spearman correlation analysis. The changes of cervical curvature, cutaneous toxicity (common terminology criteria for adverse events V3.0) and pain assessment (numerical rating scale) were compared between two groups. Qualitative data between two groups were compared by χ2 test. Quantitative data between two groups were compared by t-test. Results:Baseline features were well balanced in both groups. The setup error in the experimental group was smaller than that in the control group. For the setup error in the AP direction, the setup errors at the levels of slope, C4 and C7 in the experimental group were (0.94±0.88) mm, (1.13±1.03) mm and (1.32±1.22) mm, significantly less than (1.66±1.23) mm, (1.63±1.35) mm and (1.89±1.48) mm in the control group (all P<0.001). In the SI direction, the setup errors at the levels of slope, C4 and C7 in the experimental group were (1.14±0.87) mm, (1.31±0.93) mm and (1.39±0.95) mm, compared with (1.22±0.95) mm, (1.40±1.11) mm and (1.52±1.08) mm in the control group ( P=0.278, 0.272, 0.100). The differences in the AP direction at the level of C4 and C7 in the experimental group were smaller than those in the control group ( P=0.014, 0.005). The required PTV boundary in the AP direction in the experimental group was increased from 1.77 mm at the slope level to 2.98 mm at the level of C7. In the control group, it was increased from 3.02 mm at the slope level to 4.78 mm at the level of C7. Correlation analysis showed that at the C4 and C7 levels, and the setup errors in the SI direction were moderately negatively correlated with those in the AR direction. There were no significant differences in cervical curvature, skin toxicity and pain assessment between two groups. Conclusion:Neck muscle training can reduce the setup error in the AP direction and PTV boundary of radiotherapy in patients with nasopharyngeal carcinoma, which is worthy of clinical promotion.