下肢外骨骼机器人对关节镜下半月板修补术后患者功能重建的治疗效果

doi:10.3969/j.issn.1674-8115.2022.03.011

摘要/Abstract

摘要：

目的·探索下肢外骨骼康复机器人对关节镜下半月板修补术后康复期患者的下肢功能恢复的治疗效果，并与关节功能康复训练器（continuous passive motion，CPM）康复结果进行比较。方法·以同济大学附属同济医院骨科2020年6月至2021年6月收治的膝关节半月板损伤后行关节镜下半月板修补术的90例患者为研究对象，试验未进行双盲法分组及分配隐藏；随机将患者分为常规康复疗法联合CPM训练组（常规组，45例）和常规康复疗法联合下肢外骨骼机器人训练组（外骨骼组，45例），康复训练前收集患者的基线资料。对2组患者在康复训练前（术后4 d）和康复训练后（康复训练2个月后）的膝关节Lysholm评分分级、国际膝关节评分委员会（International Knee Documentation Committee，IKDC）膝关节主观功能评分分级、美国特种外科医院（Hospital for Special Surgery，HSS）评分、膝关节活动度进行对比分析。记录试验过程中的不良事件。结果·常规组和外骨骼组患者的性别、年龄、病程，膝关节损伤部位及分型间差异均无统计学意义（均P>0.05）。所有患者均完成2个月的康复训练。半月板修补术后常规组和外骨骼组患者康复前Lysholm评分和IKDC评分的优良率、HSS评分和膝关节活动度差异均无统计学意义（均P>0.05）；康复训练2个月后2组患者Lysholm评分和IKDC评分的优良率，以及HSS评分均较康复前显著提高（均P<0.05），且常规组Lysholm评分和IKDC评分的优良率，以及HSS评分均显著低于外骨骼组（均P<0.05）。常规组患者康复前后膝关节活动度改善无统计学意义（P>0.05），而外骨骼组康复前后膝关节活动度改善有统计学意义（P=0.000），且康复后外骨骼组膝关节活动度显著大于常规组（P=0.001）。康复训练期间，2组患者均未见明显不良反应。结论·对于关节镜下半月板修补术后康复期患者，在同时联合常规康复疗法的情况下，下肢外骨骼康复机器人比CPM对于促进膝关节功能恢复，提高膝关节活动度的效果更加显著。

关键词: 外骨骼机器人, 半月板修补术, 膝关节, 康复治疗

Abstract:

Objective·To investigate the effect of lower limb exoskeleton robot on function recovery of lower limbs in the patients during the rehabilitation period after arthroscopic meniscus repair, and compare its effect with the effect of continuous passive motion (CPM) training.

Methods·Ninety patients undergoing meniscus repair under arthroscopy after injury in the Orthopaedic Department of Tongji Hospital, Tongji University, from June 2020 to June 2021 were selected as the objects. The trial did not carry out double-blind grouping and allocation concealment. The patients were randomly divided into conventional rehabilitation therapy combined with CPM training group (conventional group, 45 cases) and conventional rehabilitation therapy combined with lower limb exoskeleton robot training group (exoskeleton group, 45 cases). The baseline data of the patients were collected before the rehabilitation training. The knee Lysholm score, the knee subjective function score of the International Knee Documentation Committee (IKDC), the Hospital for Special Surgery (HSS) score and the range of motion of knee joint were compared and analyzed between the two groups before (4 d after surgery) and after (after 2 months of rehabilitation training) the rehabilitation training. Adverse events during the test were recorded.

Results·There was no significant difference in gender, age, course of disease, location and classification of knee injury between the conventional group and the exoskeleton group (P>0.05). All the patients completed 2 months of rehabilitation training. After the meniscus repair, there was no significant difference in the excellent and good rates of Lysholm score and IKDC score, HSS score and knee range of motion between the conventional group and the exoskeleton group before rehabilitation (P>0.05). After 2 months of rehabilitation training, the excellent and good rates of Lysholm score and IKDC score, and HSS score in the two groups were significantly higher than those before rehabilitation (P<0.05), and the excellent and good rates of Lysholm score and IKDC score, and HSS score in the conventional group were significantly lower than those in the exoskeleton group (P<0.05). There was no significant difference in the improvement of knee range of motion before and after rehabilitation in the conventional group (P>0.05), while there was significant difference in the exoskeleton group (P=0.000), and the knee range of motion in the exoskeleton group after rehabilitation was significantly wider than that in the conventional group (P=0.001). During the rehabilitation training, no significant adverse effects were reported in both groups.

Conclusion·For the patients in the rehabilitation period after meniscus repair under arthroscopy, combined with the conventional rehabilitation therapy, lower limb exoskeleton rehabilitation robot is more effective than CPM in promoting the recovery of knee function and improving the range of motion of knee joint.

Key words: exoskeleton robot, meniscus repair, knee joint, rehabilitation therapy

中图分类号:

R493

王衍鸿, 韩稷钰, 万大千. 下肢外骨骼机器人对关节镜下半月板修补术后患者功能重建的治疗效果[J]. 上海交通大学学报（医学版）, 2022, 42(3): 337-343.

WANG Yanhong, HAN Jiyu, WAN Daqian. Effect of lower limb exoskeleton robot on recovery of function in patients after arthroscopic meniscus repair[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(3): 337-343.

图/表 4

参考文献 36

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Index	Conventional group （n=45）	Exoskeleton group （n=45）	Statistical value	P value
Age/year	41.44±12.56	40.11±12.30	0.509	0.612
Gender （male/female）/n	25/20	26/19	0.045	0.832
Duration/d	131.93±14.45	126.33±16.47	1.715	0.090
Right or left knee/n			0.178	0.673
Left	23	21
Right	22	24
O′Connor classification/n			0.415	0.521
Simplex type	16	15
Complex type	7	9
Longitudinal type	10	11
Radial type	5	4
Retrogressive type	4	4
Hybrid type	3	2

Index	Conventional group （n=45）	Exoskeleton group （n=45）	Statistical value	P value
Age/year	41.44±12.56	40.11±12.30	0.509	0.612
Gender （male/female）/n	25/20	26/19	0.045	0.832
Duration/d	131.93±14.45	126.33±16.47	1.715	0.090
Right or left knee/n			0.178	0.673
Left	23	21
Right	22	24
O′Connor classification/n			0.415	0.521
Simplex type	16	15
Complex type	7	9
Longitudinal type	10	11
Radial type	5	4
Retrogressive type	4	4
Hybrid type	3	2

Index	Before rehabilitation		Z value	P value	After rehabilitation		Z value	P value
Index	Conventional group （n=45）	Exoskeleton group （n=45）	Z value	P value	Conventional group （n=45）	Exoskeleton group （n=45）	Z value	P value
Excellent and good cases in Lysholm score/n（%）	21（46.67）	20（44.44）	-0.840	0.401	25（55.56）^①	33（73.33）^②	-2.002	0.045
Excellent and good cases in IKDC score/n（%）	22（46.67）	18（40.00）	-1.070	0.309	24（53.33）^①	34（75.56）^③	-2.157	0.031

Index	Before rehabilitation		Z value	P value	After rehabilitation		Z value	P value
Index	Conventional group （n=45）	Exoskeleton group （n=45）	Z value	P value	Conventional group （n=45）	Exoskeleton group （n=45）	Z value	P value
Excellent and good cases in Lysholm score/n（%）	21（46.67）	20（44.44）	-0.840	0.401	25（55.56）^①	33（73.33）^②	-2.002	0.045
Excellent and good cases in IKDC score/n（%）	22（46.67）	18（40.00）	-1.070	0.309	24（53.33）^①	34（75.56）^③	-2.157	0.031

Index	Before rehabilitation		t value	P value	After rehabilitation		t value	P value
Index	Conventional group （n=45）	Exoskeleton group （n=45）	t value	P value	Conventional group （n=45）	Exoskeleton group （n=45）	t value	P value
HSS score/point	67.89±9.95	65.02±7.92	1.512	0.134	74.87±14.09^①	83.78±13.32^②	-3.083	0.003
Knee range of motion/（°）	120.89±4.00	121.80±3.23	-1.101	0.274	122.29±9.32	128.20±6.77^②	-3.441	0.001