上海交通大学学报（医学版）

上海交通大学学报（医学版） >

2022 , Vol. 42 >Issue 3: 337 - 343

DOI: https://doi.org/10.3969/j.issn.1674-8115.2022.03.011

论著 · 临床研究

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

  • 王衍鸿 ,
  • 韩稷钰 ,
  • 万大千
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  • 同济大学附属同济医院骨关节科，上海 200065
王衍鸿（1991—），男，住院医师，硕士；电子信箱：wyh85892892@qq.com。
韩稷钰（1993—），男，住院医师，硕士；电子信箱：hanjiyudoctor@163.com。第一联系人：为共同第一作者。
万大千，电子信箱：wdqwdq1986@126.com。

收稿日期: 2021-09-03

  网络出版日期: 2022-05-09

基金资助

中央高校基本科研业务费专项资金(22120210569);上海同济医院国家自然科学基金培育项目(TJ2025)

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Effect of lower limb exoskeleton robot on recovery of function in patients after arthroscopic meniscus repair

  • Yanhong WANG ,
  • Jiyu HAN ,
  • Daqian WAN
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  • Department of Orthopaedics and Joint, Tongji Hospital, Tongji University, Shanghai 200065, China
WAN Daqian, E-mail: wdqwdq1986@126.com.

Received date: 2021-09-03

  Online published: 2022-05-09

Supported by

Fundamental Research Funds for the Central Universities(22120210569);Fostering Project of National Natural Science Foundation of China in Shanghai Tongji Hospital(TJ2025)

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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

本文引用格式

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 . DOI: 10.3969/j.issn.1674-8115.2022.03.011

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

参考文献

1 SHI Y, TIAN Z, ZHU L, et al. Clinical efficacy of meniscus plasty under arthroscopy in middle-aged and elderly patients with meniscus injury[J]. Exp Ther Med, 2018, 16(4): 3089-3093.
2 GU Y, ZHU W, HAO Y, et al. Repair of meniscal defect using an induced myoblast-loaded polyglycolic acid mesh in a canine model[J]. Exp Ther Med, 2012, 3(2): 293-298.
3 AHMED A M, BURKE D L, YU A. In-vitro measurement of static pressure distribution in synovial joints—part II: retropatellar surface[J]. J Biomech Eng, 1983, 105(3): 226-236.
4 VOLOSHIN A S, WOSK J. Shock absorption of meniscectomized and painful knees: a comparative in vivo study[J]. J Biomed Eng, 1983, 5(2): 157-161.
5 KOPF S, BEAUFILS P, HIRSCHMANN M T, et al. Management of traumatic meniscus tears: the 2019 ESSKA meniscus consensus[J]. Knee Surg Sports Traumatol Arthrosc, 2020, 28(4): 1177-1194.
6 ABRAM S G F, BEARD D J, PRICE A J, et al. Arthroscopic meniscal surgery: a national society treatment guideline and consensus statement[J]. Bone Joint J, 2019, 101-B(6): 652-659.
7 何立群, 汪毅. 中医治疗配合康复训练对半月板损伤术后重竞技运动员膝关节功能恢复的影响[J]. 中国运动医学杂志, 2013, 32(9): 784-787, 792.
8 王月光. 新编五禽戏结合CPM对退变性半月板损伤关节镜术后康复的影响[D]. 北京: 北京中医药大学, 2019.
9 SPANG III R C, NASR M C, MOHAMADI A, et al. Rehabilitation following meniscal repair: a systematic review[J]. BMJ Open Sport Exerc Med, 2018, 4(1): e000212.
10 李龙飞, 朱凌云, 苟向锋. 可穿戴下肢外骨骼康复机器人研究现状与发展趋势[J]. 医疗卫生装备, 2019, 40(12): 89-97.
11 万大千, 徐义明, 白跃宏. 下肢外骨骼康复机器人的研究与进展[J]. 中国组织工程研究与临床康复, 2011, 15(52): 9855-9858.
12 万大千, 徐义明, 白跃宏, 等. 下肢外骨骼康复机器人在膝关节活动受限康复治疗中的应用[J]. 中国组织工程研究, 2012, 16(4): 597-600.
13 邢犇. 胫骨平台骨折46例手术治疗及疗效评价[D]. 北京: 中国医科大学, 2011.
14 宣华兵, 罗新乐, 唐久阳, 等. 盘状半月板撕裂关节镜手术的回顾性分析[J]. 中华关节外科杂志(电子版), 2019, 13(6): 773-776.
15 桑井贵, 骆贤萍, 陈建芳, 等. CPM装置临床应用288例[J]. 内蒙古医学杂志, 1999, 31(1): 1-2.
16 尹悦民. CPM机在膝关节镜术后康复中的应用[J]. 当代护士(专科版), 2010(10): 61-62.
17 缪云洁. 新型下肢外骨骼的机构性能设计方法研究[D]. 上海: 上海交通大学, 2015.
18 HUSSAIN F, GOECKE R, MOHAMMADIAN M. Exoskeleton robots for lower limb assistance: a review of materials, actuation, and manufacturing methods[J]. Proc Inst Mech Eng H, 2021, 235(12): 1375-1385.
19 WANG W, LIU L, CHANG X, et al. Cross-cultural translation of the Lysholm knee score in Chinese and its validation in patients with anterior cruciate ligament injury[J]. BMC Musculoskelet Disord, 2016, 17(1): 436.
20 JIA Z Y, ZHANG C, ZOU Y M, et al. Translation and validation of the Simplified Chinese version of International Knee Documentation Committee Subjective Knee Form[J]. Arch Orthop Trauma Surg, 2018, 138(10): 1433-1441.
21 Melster A O, Strand T, Skredderstuen A, et al. Extra-articular stabilization of the knee a.m. Losee[J]. Acta Orthopaedica Scandinavica, 1984, 55(6): 640.
22 李文俊, 孙健, 刘葛君. 关节镜下全内技术股骨双隧道重建膝关节前交叉韧带[J]. 中华关节外科杂志(电子版), 2018, 12(6): 5.
23 刘建. 关节镜下成形术治疗老年膝关节半月板损伤的疗效[J]. 甘肃医药, 2020, 39(5): 418-419, 423.
24 WANG Z Q, XIONG Y, TANG X, et al. An arthroscopic repair technique for meniscal tear using a needle and suture: outside-in transfer all-inside repair[J]. BMC Musculoskelet Disord, 2019, 20(1): 614.
25 XU J, BIAN F. Pain-related risk factors after arthroscopic minimally invasive treatment of meniscus injury of knee joints[J]. Exp Ther Med, 2020, 20(3): 2317-2324.
26 CAO H, ZHANG Y, QIAN W, et al. Short-term clinical outcomes of 42 cases of arthroscopic meniscectomy for discoid lateral meniscus tears[J]. Exp Ther Med, 2012, 4(5): 807-810.
27 邓伟, 丁雪勇, 文涛. 关节镜半月板成形术联合功能锻炼治疗膝关节半月板损伤的效果及其对关节功能和活动度的影响[J]. 中国医药导报, 2016, 13(9): 108-111.
28 KANDILAKIS C, SASSO-LANCE E. Exoskeletons for personal use after spinal cord injury[J]. Arch Phys Med Rehabil, 2021, 102(2): 331-337.
29 LOUIE D R, ENG J J. Powered robotic exoskeletons in post-stroke rehabilitation of gait: a scoping review[J]. J Neuroeng Rehabil, 2016, 13(1): 53.
30 PROIETTI T, CROCHER V, ROBY-BRAMI A, et al. Upper-limb robotic exoskeletons for neurorehabilitation: a review on control strategies[J]. IEEE Rev Biomed Eng, 2016, 9: 4-14.
31 VéLEZ-GUERRERO M A, CALLEJAS-CUERVO M, MAZZOLENI S. Artificial intelligence-based wearable robotic exoskeletons for upper limb rehabilitation: a review[J]. Sensors (Basel), 2021, 21(6): 2146.
32 郭洋, 李岩, 李旗. Lokomat机器人步态康复训练对半月板损伤患者下肢功能影响[J]. 河北联合大学学报(医学版), 2016, 18(1): 12-14, 18.
33 李宏伟, 张韬, 冯垚娟, 等. 外骨骼下肢康复机器人在脑卒中康复中的应用进展[J]. 中国康复理论与实践, 2017, 23(7): 788-791.
34 NOLAN K J, KARUNAKARAN K K, CHERVIN K, et al. Robotic exoskeleton gait training during acute stroke inpatient rehabilitation[J]. Front Neurorobot, 2020, 14: 581815.
35 向小娜, 宗慧燕, 何红晨. 下肢外骨骼康复机器人对脊髓损伤患者步行能力改善的研究进展[J]. 中国康复医学杂志, 2020, 35(1): 119-122.
36 FERREIRA DOS SANTOS L, CHRIST O, MATE K, et al. Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review[J]. Biomed Eng Online, 2016, 15(Suppl 3): 144.
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