下肢康复机器人临床应用专家共识  

Expert Consensus on Clinical Application of Lower Limb Rehabilitation Robots

作　　者：张立新[1] 白定群[2] 白玉龙[3] 陈文华[4] 陈艳[5] 杜青[6] 范茂华[5] 何红晨[7] 黄丽萍[8] 贾杰[3] 李建华[9] 李磊 潘钰[11] 苏敏[12] 王宏图[13] 尹勇 张弼 ZHANG Lixin;BAI Dingqun;BAI Yulong;CHEN Wenhua;CHEN Yan;DU Qing;FAN Maohua;HE Hongchen;HUANG Liping;JIA Jie;LI Jianhua;LI Lei;PAN Yu;SU Min;WANG Hongtu;YIN Yong;ZHANG Bi(Shengjing Hospital of China Medical University,Shenyang,Liaoning 110004,China;The First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China;Huashan Hospital,Fudan University,Shanghai 200040,China;Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080,China;The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou,Guangdong 510260,China;Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;West China Hospital,Sichuan University,Chengdu,Sichuan 610044,China;The First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou,Zhejiang 310016,China;Guangdong Zhongxin Intelligent Rehabilitation Institute,Foshan,Guangdong 528200,China;Beijing Tsinghua Changgung Hospital,Beijing 102218,China;Dushu Lake Hospital Affiliated to Soochow University,Suzhou,Jiangsu 215128,China;Tianjin Huanhu Hospital,Tianjin 300350,China;Hospital of Yunnan University,Kunming,Yunnan 650021,China;Shenyang Institute of Automation,Chinese Academy of Sciences,Shenyang,Liaoning 110017,China)

机构地区：[1]中国医科大学附属盛京医院,辽宁沈阳110004 [2]重庆医科大学附属第一医院,重庆400042 [3]复旦大学附属华山医院,上海200040 [4]上海交通大学医学院附属第一人民医院,上海200080 [5]广州医科大学附属第二医院,广东广州510260 [6]上海交通大学医学院附属新华医院,上海200092 [7]四川大学华西医院,四川成都610044 [8]解放军总医院第一医学中心,北京100853 [9]浙江大学附属邵逸夫医院,浙江杭州310016 [10]广东中新智能康复研究院,广东佛山528200 [11]清华大学附属北京清华长庚医院,北京102218 [12]苏州大学康复研究所/苏州大学附属独墅湖医院,江苏苏州215128 [13]天津市环湖医院,天津300350 [14]云南大学附属医院,云南昆明650021 [15]中国科学院沈阳自动化研究所,辽宁沈阳110017

出　　处：《康复学报》2023年第5期383-396,共14页Rehabilitation Medicine

基　　金：国家重点研发计划项目(2020YFC2005700,2020YFC2007604);国家自然科学基金项目(62273336);辽宁省自然科学基金项目(2022-YGJC-58)。

摘　　要：随着下肢康复机器人在运动功能康复中的应用逐渐增多,需要对我国下肢康复机器人临床应用进行规范和建议。本共识结合我国下肢康复机器人在偏瘫、截瘫、脑瘫及其他下肢功能障碍患者康复治疗中应用的特点,并参考最新研究,对下肢康复机器人的作用原理、分类介绍、临床应用(适应证和禁忌证、作用参数、操作流程、治疗安全性)以及临床应用推荐(偏瘫、截瘫、骨关节疾病、儿童疾病和其他系统疾病)等方面进行阐述,以期为更好地应用下肢康复机器人提供临床指导意见。下肢康复机器人适用于步行功能障碍、长期卧床的患者,根据患者在康复训练中的体位,大致可分为坐卧式机器人、直立式机器人和辅助起立式机器人。下肢机器人的治疗参数是由患者肢体长度、下肢活动范围、肌肉张力和体质量决定的,其中引导力、步速与减重是重要调整参数。影响下肢康复机器人使用的安全性影响因素较多,通常需要通过监测使用过程中的不良反应发生来评估安全性。研究表明下肢康复机器人训练联合常规康复治疗或其他新兴康复技术(如虚拟现实、经颅直流电刺激等)可改善脑卒中后偏瘫患者的运动功能,但其训练效果是否优于常规康复训练,需进行进一步的临床试验验证(高级证据);下肢康复机器人训练可改善截瘫患者的步行功能(中-高级证据)、心肺功能(低-中级证据)、下尿路功能(低级证据)、平衡功能(低-中级证据),中级证据表明合并下肢痉挛的截瘫患者可进行下肢康复机器人训练;下肢机器人训练能够改善骨关节疾病患者的疼痛、关节活动度、下肢肌肉力量以及步行能力,目前主要用于全膝关节置换术后(中级证据)、全髋关节置换术后(中-低级证据)和骨关节炎(中-低级证据);下肢康复机器人辅助步态训练(中级证据)和关节活动度训练(低级证据)有益�With the gradual increase in the application of lower limb robots in motor function rehabilitation,there is a need to standardize the clinical application of lower limb rehabilitation robots in China.This consensus integrates the characteristics of lower limb rehabilitation robots applications in the treatment for patients with hemiplegia,paraplegia,cerebral palsy,and other common lower limb dysfunctions in China.In addition,referencing the latest research,this consensus elaborates on the working principles,classification,clinical application(indications and contraindications,working parameters and operating procedures,safety),and recommendations on clinical application(hemiplegia,paraplegia,musculoskeletal diseases,childhood diseases and other systemic diseases)when using lower limb rehabilitation robots in the current context.Lower limb rehabilitation robots are well-suitable for patients with walking difficulties and long-term bedridden condition.According to the patient's posture during rehabilitation training,they can be classified into sitting or supine robots,upright robots,and assisted upright robots.The treatment parameters of lower limb robots are determined by the patient's weight and lower limb's length,range of motion,and muscle strength,among which guiding force,walking speed,and anti-gravity are important parameters that need to be adjusted.There are many factors that affect the safety using of lower limb rehabilitation robots,and it is usually necessary to evaluate the safety by monitoring the occurrence of adverse events during robot training.Studies have shown that combining lower limb rehabilitation robot training with conventional rehabilitation therapy or emerging rehabilitation technologies such as virtual reality and transcranial direct current stimulation improves motor function in stroke patients with hemiplegia.However,determining whether its training effect is superior to conventional rehabilitation therapy requires further clinical study(high-level evidence).Studies have also shown tha

关 键 词：下肢康复机器人 功能障碍 分类 临床应用 专家共识 

分 类 号：TP242[自动化与计算机技术—检测技术与自动化装置] R496[自动化与计算机技术—控制科学与工程]