康复机器人辅助训练对脑卒中患者偏瘫上肢功能的影响：基于剪切波弹性成像技术的探索

关键词：脑卒中  上肢运动功能  剪切波弹性成像技术  上肢康复机器人

Keywords:stroke  upper-limb motor function  shear wave elastography  upper limb rehabilitation robot

摘要：

      摘要 目的：观察上肢康复机器人辅助训练对脑卒中患者偏瘫上肢运动功能的影响，结合超声剪切波弹性成像技术进行肌纤维定量参数测评，并探讨该技术在脑卒中康复疗效评估中的应用价值。 方法：将2024年8月—2025年2月新疆维吾尔自治区人民医院康复医学科收治的61例脑卒中后上肢功能障碍的患者，按随机数字法分为对照组31例、试验组30例。对照组患者接受常规康复训练，每天1次，每次60min，每周7次，连续训练3周；试验组患者接受常规康复训练40min加上肢康复机器人辅助训练20min，同样每天1次，每周7次，连续训练3周。治疗前后两组均采用Brunnstrom（BRS）进行脑卒中运动功能分期，用Fugl-Meyer上肢评定法（FMA-UE）、改良Ashworth量表（MAS）、改良Barthel指数量表（MBI）进行疗效评估；并用剪切波弹性成像（SWE）技术进行肌纤维定量参数测评。 结果：治疗后两组患者分别与治疗前相比：①FMA-UE、MBI的差异均有显著性意义（P<0.05），且试验组评分显著高于对照组（P<0.05）；BRS在试验组差值有显著性意义（P<0.05），但和对照组对比无显著性意义（P>0.05）；MAS组内及组间对比差异均无显著性意义（P>0.05）。②SWE：试验组与对照组三角肌中束，肱二头肌、肱桡肌放松位及拉伸位的G值差异均有显著性意义（P<0.05），且试验组显著优于对照组（P<0.05）；试验组肱三头肌放松位的G值较治疗前增高，差值有显著性意义（P<0.05），且与对照组相比有显著性意义（P<0.05）；试验组三角肌前束、对照组三角肌后束放松位G值显著提高（P<0.05），但两组间比较无显著性差异（P>0.05）；试验组三角肌前束、对照组三角肌后束、肱三头肌拉伸位G值组内及组间相比，差异均无显著性意义（P>0.05）。 结论：上肢康复机器人辅助训练在改善脑卒中患者上肢运动功能及降低屈肌痉挛方面优于常规康复训练。SWE技术可量化评估脑卒中患者肌肉结构参数。

Abstract:

      Abstract Objective：To observe the effect of robot-assisted upper-limb training on motor function in stroke patients with hemiplegia， utilizing ultrasound shear wave elastography （SWE） for quantitative assessment of muscle fiber parameters， and to explore the application value of SWE in evaluating stroke rehabilitation outcomes. Method： Sixty-one stroke patients with upper-limb dysfunction admitted to the Department of Rehabilitation Medicine， People's Hospital of Xinjiang Uygur Autonomous Region between August 2024 and February 2025 were randomly assigned to a control group （n=31） or an experimental group （n=30） using a random number table. The control group received conventional rehabilitation training （60 minutes/session， once daily， 7 sessions/week for 3 weeks）. The experimental group received conventional training （40 minutes） plus upper limb robot-assisted training （20 minutes）， with the same frequency and duration. Both groups were assessed before and after treatment using the Brunnstrom recovery stage （BRS） for motor staging， Fugl-Meyer Assessment for Upper Extremity （FMA-UE）， modified Ashworth scale （MAS）， and modified Barthel index（MBI）. SWE was used to measure quantitative muscle fiber parameters. Result： After treatment， both groups showed statistically significant improvements in FMA-UE and MBI scores compared to baseline （P<0.05）， with significantly greater improvement in the experimental group （P<0.05）. BRS scores improved significantly within the experimental group （P<0.05） but showed no significant between-group difference （P>0.05）. MAS scores showed no significant within- or between-group differences （P>0.05）. The shear modulus (G-value) of the middle deltoid, biceps brachii, and brachioradialis (in both relaxed and stretched states) improved significantly in the experimental group compared with the control group (P<0.05). The experimental group also showed a significant increase in the triceps brachii G-value in the relaxed state compared with both baseline and the control group (P<0.05). Significant within-group improvements （P<0.05） were seen in the anterior deltoid （experimental group） and posterior deltoid （control group） in the relaxed state， but no significant between-group differences existed （P>0.05）. No significant within- or between-group differences were found in the G-value of the anterior deltoid （experimental）， posterior deltoid （control）， or triceps brachii in the stretched state （P>0.05）. Conclusion： Upper-limb rehabilitation robot-assisted training is superior to conventional rehabilitation training in improving upper-limb motor function and reducing flexor spasticity in stroke patients. SWE technology can be used in quantitatively assessing muscle structural parameters in stroke patients.