下肢外骨骼在帕金森病脑深部电刺激术后步态障碍康复中的初步应用

Preliminary application of lower extremity exoskeletons in the rehabilitation of gait disorders after deep brain stimulation for Parkinson's disease

目的探讨应用下肢外骨骼系统辅助帕金森病(PD)患者脑深部电刺激术后程控和步态障碍康复治疗的临床效果和初步经验。方法前瞻性纳入2019年6月至2023年6月南京医科大学附属脑科医院功能神经外科行双侧丘脑底核脑深部电刺激术后步态障碍症状波动的PD患者,共10例。术前Hoehn-Yahr分级为2.5级2例,3.0级5例,4.0级3例。采用外骨骼系统进行力反馈训练和步态姿势矫正训练,通过监测步态数据来进行程控。采用配对t检验对比分析首次训练前与末次训练后患者的双下肢摆动相占比、双下肢步幅、步速和步频,以评估疗效。结果10例患者均在下肢外骨骼系统辅助训练下调整程控参数,每个周期训练4次,共2~4个周期。与首次训练前比较,PD患者末次训练后双下肢的摆动相占比增加[左侧为(27.57±2.39)%对比(24.30±2.75)%;右侧为(27.38±2.96)%对比(23.15±2.77)%]、双下肢步幅均增加[左侧为(0.83±0.16)m对比(0.55±0.18)m;右侧为(0.83±0.16)m对比(0.55±0.17)m]、步速增加[(0.73±0.18)m/s对比(0.46±0.14)m/s],差异均具有统计学意义(均P<0.05);而步频较训练前无明显改善[(106.80±15.50)步/min对比(103.84±10.53)步/min,P=0.559]。结论初步研究发现,应用下肢外骨骼系统辅助PD患者脑深部电刺激术后程控和康复治疗可在一定程度上改善患者的步态障碍。

Objective To investigate the clinical effect and preliminary experience of programming and rehabilitation after deep brain stimulation for Parkinson's disease(PD)patients with gait disorder assisted by an exoskeleton system.Methods A total of 10 patients with PD with fluctuating gait disorder symptoms after bilateral deep brain stimulation(DBS)of the subthalamic nucleus(STN)in the Department of Functional Neurosurgery,the Affiliated Brain Hospital of Nanjing Medical University from June 2019 to June 2023.Before operation,Hoehn-Yahr grade 2.5 was reported in 2 cases,3.0 in 5 cases,and 4.0 in 3 cases.The exoskeleton system was used for force feedback training and gait posture correction training,and the gait data was monitored for DBS programming.The paired t-test was used to compare and analyze the swing phase of both lower limbs,stride length,velocity and cadence of both lower limbs before the first training and after the last training to evaluate the efficacy.Results All 10 patients were trained with the lower limb exoskeleton system to adjust the DBS programming parameters,and each round of training was 4 times with a total of 2-4 rounds.Compared with before the first training,the swing phase in both lower limbs increased afer the last training[(27.57±2.39)%vs.(24.30±2.75)%on the left side;(27.38±2.96)%vs.(23.15±2.77)%on the right side],the stride length of both lower limbs increased(0.83±0.16 m us.0.55±0.18 m on the left side;0.83±0.16 m us.0.55±0.17 m on the right side),the velocity increased(0.73±0.18 m/s us.0.46±0.14 m/s),and the difference was statistically significant(all P<0.05),while the cadence was not significantly improved(106.80±15.50 steps/min vs.103.84±10.53 steps/min,P=0.559).C Conclusion Preliminary studies have suggested that the application of lower limb exoskeleton system to assist postoperative programming and rehabilitation therapy of DBS in PD patients can improve the gait disorder of patients to a certain extent.