体位限制下康复机器人训练对脑卒中后肩关节半脱位患者上肢功能的效果

doi:10.3969/j.issn.1006-9771.2024.03.007

摘要/Abstract

摘要：

目的探讨体位限制下上肢康复机器人训练对脑卒中后肩关节半脱位患者上肢功能的临床疗效。

方法 2023年3月至12月，蚌埠医科大学第一附属医院脑卒中后肩关节半脱位患者60例随机分为常规组(n = 20)、机器人组(n = 20)和体位限制组(n = 20)。3组均进行常规康复治疗，机器人组行上肢康复机器人训练，体位限制组在体位限制下行上肢康复机器人训练，共4周。治疗前后采用Fugl-Meyer评定量表上肢部分(FMA-UE)、改良Barthel指数(MBI)进行评定，表面肌电图(sEMG)检测三角肌后束和冈上肌收缩时的平均肌电值(AEMG)和均方根值(RMS)，肌骨超声测量患侧肩峰-大结节(AGT)间距。

结果治疗后，3组FMA-UE评分、MBI评分、AEMG、RMS和AGT间距均较治疗前显著改善(|t| > 10.850, P < 0.001)，体位限制组各项指标最优(F > 42.031, P < 0.001)。

结论体位限制下上肢康复机器人训练能进一步改善脑卒中后肩关节半脱位患者的上肢功能及脱位状态、提高日常生活能力及肩周肌肉功能。

关键词: 脑卒中, 肩关节半脱位, 上肢机器人, 康复

Abstract:

Objective To explore the effect of robotic training under position limitation on upper limb of patients with shoulder subluxation after stroke.

Methods From March to December, 2023, sixty patients with shoulder subluxation after stroke in the First Affiliated Hospital of Bengbu Medical University were randomized into conventional group (n = 20), robot group (n = 20) and position-limited group (n = 20). All the groups accepted conventional rehabilitation, while the robot group underwent robot training and the position-limited group underwent robot training under position limitation, for four weeks. Before and after treatment, Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) were used for evaluation, surface electromyography (sEMG) was used to measure the average electromyography (AEMG) and root mean square (RMS) of posterior deltoid fasciculus and supraspinatus during contraction, and musculoskeletal ultrasonography was used to determine the distance of acromion-greater tuberosity (AGT) of the affected side.

Results After treatment, FMA-UE score, MBI score, AEMG, RMS and the distance of AGT improved in all the groups (|t| > 10.850, P< 0.001), and all the indexes were optimal in the position-limited group (F> 42.031, P< 0.001).

Conclusion Robotic training for upper limb under postural limitation can further improve upper limb function and subluxation status, activities of daily living, and peri-shoulder muscle in patients with shoulder subluxation after stroke.

Key words: stroke, shoulder subluxation, upper extremity robot, rehabilitation

中图分类号:

R743.3

刘换, 韩雪, 宋佳苧, 娄晓乐, 徐磊. 体位限制下康复机器人训练对脑卒中后肩关节半脱位患者上肢功能的效果[J]. 《中国康复理论与实践》, 2024, 30(3): 303-309.

LIU Huan, HAN Xue, SONG Jianing, LOU Xiaole, XU Lei. Effect of robotic training under position limitation on upper limbs in patients with shoulder subluxation after stroke[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 303-309.

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组别	n	性别(男/女)/n	年龄/岁	病程/d	患侧(左/右)/n	性质(出血/梗死)/n
常规组	20	14/6	58.85±10.16	58.40±15.47	13/7	9/11
机器人组	20	13/7	54.90±9.22	53.35±12.87	12/8	9/11
体位限制组	20	12/8	59.85±11.52	57.70±13.45	12/8	10/10
χ²/F值		0.440	1.217	0.728	0.141	0.134
P值		0.803	0.304	0.487	0.932	0.935

组别	n	治疗前	治疗后	t值	P值
常规组	20	24.10±1.48	32.20±1.29	-18.899	< 0.001
机器人组	20	24.05±1.36	35.20±1.29^a	-27.932	< 0.001
体位限制组	20	24.30±1.58	38.00±1.45^a,b	-33.331	< 0.001
F值		0.152	88.480
P值		0.859	< 0.001

组别	n	治疗前	治疗后	t值	P值
常规组	20	50.55±1.56	58.90±1.37	-17.915	< 0.001
机器人组	20	50.35±1.68	63.15±1.39^a	-26.128	< 0.001
体位限制组	20	50.50±1.69	65.85±1.39^a,b	-29.264	< 0.001
F值		0.076	121.797
P值		0.927	< 0.001

组别	n	治疗前	治疗后	t值	P值
常规组	20	18.90±1.84	30.65±1.59	-25.976	< 0.001
机器人组	20	19.00±1.45	34.00±1.45^a	-28.401	< 0.001
体位限制组	20	18.95±1.91	35.85±1.85^a,b	-34.384	< 0.001
F值		0.016	49.163
P值		0.985	< 0.001

组别	n	治疗前	治疗后	t值	P值
常规组	20	23.35±1.68	38.05±1.43	-36.334	< 0.001
机器人组	20	23.95±1.56	42.00±1.45^a	-45.069	< 0.001
体位限制组	20	23.80±1.69	44.35±1.71^a,b	-43.463	< 0.001
F值		0.683	81.660
P值		0.509	< 0.001