平衡障碍康复机器人在老年下肢骨折患者术后康复中的应用效果研究

背景　据第七次全国人口普查结果，我国60岁及以上人口为26 402万，与2010年相比，人口比重上升5.44个百分点。随着人口老龄化程度进一步加深，老年人跌倒后下肢骨折患者的术后康复提到了新的重视高度。面对目前康复医师缺乏、康复策略单一及康复医师主观判断等诸多不利因素，平衡障碍康复机器人可能是一种更为安全有效的康复训练方法。目的　分析平衡障碍康复机器人在老年人跌倒引起的下肢骨折患者术后康复中的应用效果。方法　选取成都大学附属医院骨科病区、解放军总医院康复科病区2020年4-10月收治的100例因跌倒致下肢骨折手术的老年患者为研究对象，按计算机随机分组法分为试验组50例和对照组50例，治疗过程中试验组脱落3例，对照组脱落2例。对照组（n=48）采用物理作业治疗联合减重步行康复训练，试验组（n=47）采用物理作业治疗联合平衡障碍康复机器人辅助康复训练。训练16周后采用姿态传感器采集受试者双足跨步时间、3 m直行步速、3 m直行步长；分别于术后训练第8周末、第12周末、第16周末进行Berg平衡量表评分。结果　两组性别、年龄、BMI比较，差异无统计学意义（P>0.05）；两组病程比较，差异有统计学意义（P<0.05）。试验组左右足跨步平均时间均短于对照组，差异有统计学意义（P<0.05）；试验组左右足3 m直行平均步速及3 m直行平均步长均优于对照组，差异有统计学意义（P<0.05）。两组训练与时间的交互作用具有统计学意义（F交互=53.116，P交互<0.001）；两组间下肢运动功能恢复程度不同，差异有统计学意义（F组间=3.675，P组间=0.013）；两组组内不同观察时间点的Berg评分值差异有统计学意义（F时间=1 364.425，P时间<0.001）。结论　相对于减重步行康复训练，平衡障碍康复机器人对老年人跌倒引起下肢骨折术后的下肢运动功能康复效果更好，但随着康复时间延长，下肢功能恢复能力提升较为缓慢。

Clinical Application of Balance Disorder Rehabilitation-assisted Robot in Postoperative Rehabilitation of Elderly Patients with Fall-related Lower Limb Fractures

Background　According to the results of China's seventh national census，Chinese population aged 60 and above is 264.02 million，the proportion of which，compared with that of 2010，has increased by 5.44 percentage points. The accelerated population aging has aroused increased concerns about postoperative rehabilitation of elderly patients with lower limb fractures after fall. Given many unfavorable factors for postoperative rehabilitation，such as lack of rehabilitation physicians，few rehabilitation schemes，and nonuniform subjective judgment of rehabilitation physicians，robot-associated balance disorder rehabilitation might be a safer and more effective rehabilitation training choice. Objective　To explore the clinical effect of balance disorder rehabilitation-assisted robot in postoperative rehabilitation of elderly patients with fall-related lower limb fractures. Methods　One hundred elderly patients with lower limb fractures caused by fall were recruited from Orthopedic Ward，Affiliated Hospital of Chengdu University and Chinese PLA General Hospital from April to October 2020，and equally divided into case group and control group using a computer algorithm，receiving physical exercise therapy with robot-assisted balance disorder rehabilitation，physical exercise therapy with walking for weight loss，respectively. Major indicators for postoperative rehabilitation effect were stride time，speed of 3-meter straight walking and step size of 3-meter straight walking measured by the attitude sensor at the end of the 16th week of postoperative training，and the Berg Balance Scale score measured at the end of the 8th，12th and 16th weeks of postoperative training. Results　All the participants were included for final analysis except 5 dropouts（3 in the case group，and 2 in the control group）. Two groups showed no significant differences in gender ratio，and mean age and BMI（P>0.05）. The mean course of fractures differed significantly between the groups（P<0.05）. The case group had much shorter mean left and right stride time than the control group（P<0.05）. The case group had quicker average speed of 3-meter straight walking and greater average step size of 3-meter straight walking（P<0.05）. The interaction between training contents and time was statistically significant in both groups（F=53.116，P<0.001）. The recovery degree of lower limb motor function was different between the two groups（F=3.675，P=0.013）. The Berg Balance Scale scores for both groups differed significantly by measurement time（F=1 364.425，P<0.001）. Conclusion　For older adults with fall-related lower limb fractures，robot-assisted balance disorder rehabilitation may yield a better outcome concerning lower limb motor function recovery compared with walking for weight loss，but the speed of recovery may slow down with the extension of rehabilitation time.