功能性电刺激同步下肢康复机器人对脑卒中后足下垂患者踝部功能的疗效研究

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摘要目的观察功能性电刺激（FES）同步Lokomat 下肢康复机器人对脑卒中后足下垂患者踝部功能和步行能力的临床疗效。方法选取2017年9月～2019年8月福建中医药大学附属康复医院收治的40 例脑卒中患者作为研究对象，采用随机数字表法将其分为对照组（n=20）和实验组（n=20）。对照组患者采用FES 同步人工辅助平地步行训练，实验组患者采用FES 同步Lokomat 下肢康复机器人辅助步行训练。治疗前和治疗4 周后，比较两组患者踝背伸胫前肌和踝跖屈腓肠肌的积分肌电图（iEMG）、拮抗肌协同收缩率（CR）、综合痉挛量表（CSS）、功能性步行量表（FAC）、10 m 最大步行速度（10MWT）。结果治疗前，两组患者的踝背伸胫前肌iEMG、踝跖屈腓肠肌iEMG、踝背伸拮抗肌CR、踝跖屈拮抗肌CR、CSS 评分、FAC 评分、10MWT 比较，差异无统计学意义（P＞0.05）。治疗后，两组患者的踝背伸胫前肌iEMG、踝跖屈腓肠肌iEMG、FAC 评分均高于治疗前，差异有统计学意义（P＜0.05）；治疗后，两组患者的踝背伸拮抗肌CR 高于治疗前，踝跖屈拮抗肌CR、CSS 评分低于治疗前，10MWT 均大于治疗前，差异有统计学意义（P＜0.05）；治疗后，实验组患者的踝背伸胫前肌iEMG、踝跖屈腓肠肌iEMG、FAC 评分均高于对照组，10MWT 大于对照组，差异有统计学意义（P＜0.05）；治疗后，实验组患者的踝背伸拮抗肌CR 高于对照组，踝跖屈拮抗肌CR、CSS 评分低于对照组，差异有统计学意义（P＜0.05）。结论 FES 同步Lokomat 下肢康复机器人辅助步行训练，能明显改善脑卒中后足下垂患者的踝部功能和步行能力。

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关键词 ：脑卒中, 下肢康复机器人, 功能性电刺激, 足下垂

Abstract：Objective To explore the clinical effect of functional electrical stimulation(FES)synchronous Lokomat lower limb rehabilitation robot on ankle function in patients with foot droop after cerebral apoplexy.Methods A total of 40 patients with stroke admitted to the Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine from September 2017 to August 2019 were selected as the research objects,and they were divided into control group(n=20)and experimental group(n=20)by random number table method.Patients in the control group received FES synchronous artificial assisted walking training,and patients in the experimental group received FES synchronous Lokomat lower limb rehabilitation robot assisted walking training.Before treatment and 4 weeks after treatment,the integrated electromyography(iEMG),the EMG co-contraction ratio(CR)of the ankle-dorsal extensor tibialis anterior muscle and ankle-plantar flexor gastrocnemius muscle,composite spasticity scale(CSS),functional ambulation category(FAC),and 10 meter maximum walking speed(10MWT)were compared between the two groups.Results Before treatment,there were no significant differences in iEMG of ankle-dorsal extensor tibialis anterior muscle,iEMG of ankleplantar flexor gastrocnemius muscle,CR of ankle-dorsal extensor antagonist muscle,CR of ankle-plantar flexor gastrocnemius muscle,CSS score,FAC score and 10MWT between the two groups(P＞0.05).After treatment,the iEMG of ankle-dorsal extensor tibialis anterior muscle,iEMG of ankle-plantar flexor gastrocnemius muscle,FAC scores in the two groups were higher than those before treatment,with statistical significances(P＜0.05).After treatment,the CR of ankle-dorsal extensor antagonist muscle in the two groups were higher than those before treatment,CR of ankle-plantar flexor gastrocnemius muscle and CSS scores in the two groups were lower than those before treatment,10MWT in the two groups were all higher than those before treatment,with statistically significant differences(P＜0.05).After treatment,the iEMG of ankle-dorsal extensor tibialis anterior muscle,iEMG of ankle-plantar flexor gastrocnemius muscle,FAC scores in the experimental group were all higher than those in control group,and 10MWT in the experimental group was higher than that in control group,with statistically significant differences(P＜0.05).After treatment,the CR of ankle-dorsal extensor antagonist muscle in the two groups were higher than those before treatment,CR of ankle-plantar flexor gastrocnemius muscle and CSS scores in the experimental group were lower than those in the control group,10MWT in the experimental group was higher than that in the control group,with statistically significant differences(P＜0.05).Conclusion FES synchronous Lokomat lower limb rehabilitation robot assisted walking training,can significantly improve the ankle function and walking ability of patients with foot droop after cerebral apoplexy.

Key words： Cerebral apoplexy Lower limb rehabilitation robot Functional electrical stimulation Foot drop

基金资助:中央引导地方科技发展专项（2018L3009）；福建省卫生计生青年科研课题（2017-2-53）

作者简介: 刘燕平（1989-），女，福建武平人，硕士，主管治疗师，研究方向：神经疾病康复和产后康复

引用本文:

刘燕平；林茜；陈登钟；李中元；马启寿；杨煌. 功能性电刺激同步下肢康复机器人对脑卒中后足下垂患者踝部功能的疗效研究[J]. 中国当代医药, 2021, 28(13): 46-50.
LIU Yan-ping；LIN Qian；CHEN Deng-zhong；LI Zhong-yuan；MA Qi-shou；YANG Huang. Efficacy study of functional electrical stimulation synchronous lower limb rehabilitation robot on ankle function in patients with foot droop after cerebral apoplexy. 中国当代医药, 2021, 28(13): 46-50.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2021/V28/I13/46

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