康复外骨骼机器人对脑卒中下肢运动功能障碍疗效的Meta分析  

Efficacy of rehabilitation exoskeleton robots on post-stroke lower limb motor dysfunction:a Meta-analysis

作　　者：常万鹏 张钟文[2] 杨钰琳 訾阳 杨梦琦 杜冰玉 王楠[1] 于少泓[3,4] Chang Wanpeng;Zhang Zhongwen;Yang Yulin;Zi Yang;Yang Mengqi;Du Bingyu;Wang Nan;Yu Shaohong(College of Rehabilitation Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355,Shandong Province,China;The First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Jinan 250014,Shandong Province,China;The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250001,Shandong Province,China;College of Medicine,Shandong University of Traditional Chinese Medicine,Jinan 250355,Shandong Province,China)

机构地区：[1]山东中医药大学康复医学院,山东省济南市250355 [2]山东第一医科大学第一附属医院山东省千佛山医院,山东省济南市250014 [3]山东中医药大学第二附属医院,山东省济南市250001 [4]山东中医药大学医学院,山东省济南市250355

出　　处：《中国组织工程研究》2024年第2期321-328,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(青年项目)(82000788),项目负责人:张钟文;横向课题:HX-2020-13(SDAM202009003),项目负责人:于少泓。

摘　　要：目的:运用Meta分析方法系统评价康复外骨骼机器人对脑卒中患者下肢运动功能的康复疗效,并比较不同下肢外骨骼机器人的疗效差异,为脑卒中下肢运动功能障碍患者选择适合的外骨骼机器人提供科学理论依据。方法:计算机检索Cochrane Library、PubMed、Web of Science、Embase、中国知网、维普和万方数据库的相关文献,收集从建库至2022年11月发表的关于探讨下肢康复外骨骼机器人改善脑卒中患者下肢运动功能的随机对照临床试验。由2名研究人员进行文献检索与筛选,使用Cochrane 5.1.0偏倚风险评估工具和Jadad量表对纳入文献进行质量评价。采用RevMan 5.4和Stata 17.0软件对结局指标进行Meta分析。结果:①最终纳入22篇文献,Jadad评分显示均为高质量文献,共865例患者,试验组436例、对照组429例。②Meta分析结果显示,与对照组相比,外骨骼机器人可显著提高脑卒中患者下肢运动功能(Fugl-Meyer Assessment of Lower Extremity,FMA-LE)评分(MD=2.63,95%CI:1.87-3.38,P<0.05)、平衡功能(Berg Balance Scale,BBS)评分(MD=3.62,95%CI:1.21-6.03,P<0.05)、站起-走测试量表(Timed Up and Go,TUG)评分(MD=-2.77,95%CI:-4.48至-1.05,P<0.05)和步频(MD=3.15,95%CI:1.57-4.72,P<0.05),但对功能性步行量表(Functional Ambulation Category Scale,FAC)评分(MD=0.30,95%CI:-0.01-0.61,P>0.05)和6 min步行测试(6-minute walk test,6MWT)评分(MD=3.77,95%CI:-6.60-14.14,P>0.05)的提高不明显。③网状Meta分析结果显示,FMA-LE评分:平地行走式外骨骼(MD=10.23,95%CI:3.81-27.49,P<0.05)和减重式外骨骼(MD=33.66,95%CI:11.49-98.54,P<0.05)与常规康复治疗相比均能改善FMA-LE评分,排序结果为减重式外骨骼>平地行走式外骨骼>常规康复治疗;BBS评分:减重式外骨骼(MD=79.86,95%CI:2.34-2725.99,P<0.05)与常规康复治疗相比能显著改善BBS评分,排序结果为减重式外骨骼>平地行走式外骨骼>常规康复治疗;FAC评分:平地行走式外骨骼(MD=1.38,95%CI:1.00-1OBJECTIVE:To systematically evaluate the efficacy of rehabilitation exoskeleton robots on the lower limb motor function of stroke patients using Meta-analysis and to compare the efficacy of different lower limb exoskeleton robots,so as to provide a theoretical basis for the scientific selection of suitable exoskeleton robots for patients with post-stroke lower limb motor dysfunction.METHODS:Computer searches of the Cochrane Library,PubMed,Web of Science,Embase,CNKI,VIP,and WanFang Data were conducted to collect randomized controlled clinical studies on exploring lower extremity rehabilitation exoskeleton robots to improve lower limb motor function in stroke patients published from database inception to November 2022.Two researchers conducted the literature search and screening.The quality of the included literature was evaluated using the Cochrane 5.1.0 risk of bias assessment tool and the Jadad scale.Meta-analysis was performed using RevMan 5.4 and Stata 17.0 software.RESULTS:(1)Finally 22 publications were included,involving 865 patients(n=436 in the test group and n=429 in the control group),and the Jadad score showed that all the included articles were of high quality.(2)Meta-analysis results showed that the exoskeleton robot significantly improved the Fugl-Meyer Assessment of Lower Extremity score(mean difference[MD]=2.63,95%confidence interval[CI]:1.87-3.38,P<0.05),Berg Balance Scale score(MD=3.62,95%CI:1.21-6.03,P<0.05),Timed Up and Go score(MD=-2.77,95%CI:-4.48 to-1.05,P<0.05)and step frequency score(MD=3.15,95%CI:1.57-4.72,P<0.05)in stroke patients compared with the control group.However,there was no significant improvement in the Functional Ambulation Category Scale score(MD=0.30,95%CI:-0.01 to 0.61,P>0.05)and 6-minute walk test score(MD=3.77,95%CI:-6.60 to 14.14,P>0.05).(3)Network Meta-analysis results showed that compared with the conventional rehabilitation therapy,both the level-walking exoskeleton(MD=10.23,95%CI:3.81-27.49,P<0.05)and the bodyweight support exoskeleton(MD=33.66,95%CI:11.49-98.54,P<0

关 键 词：脑卒中 中风 下肢运动功能 步态 步行 平衡 康复机器人 外骨骼 系统评价 网状Meta分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R608