目的：研究重症颅脑损伤（sTBI）患者去骨瓣减压术（DC）后采取上肢康复机器人训练（ULRRT）联 合虚拟现实（VR）互动干预后，其日常生活能力、神经功能、认知功能和肢体功能的改善情况。同时，依照“认知 行为理论”，探讨认知功能、神经功能在肢体功能对日常生活行为的关系中的中介效应。方法：回顾性分析 2019 年 1 月—2023 年 6 月于西安交通大学第一附属医院治疗的 92 例 sTBI 患者的临床资料，根据可比性原则按不同干预方 式将其划分为机器人组（32 例，常规干预 + 上肢康复机器人干预）、VR 组（26 例，常规干预 +VR 互动干预）、 联合组（34 例，常规干预 + 上肢康复机器人干预 +VR 互动干预）。采用美国国立卫生院卒中量表（NIHSS）、简易 精神状态检查（MMSE）、上肢运动功能评定量表（FMA-UE）及日常生活能力量表（ADL）分别评估并比较三组患 者的神经功能、认知功能、上肢功能及日常生活能力。结果：干预后，联合组 MMSE、FMA-UE、ADL 评分均高于 机器人组、VR 组（P<0.05），而联合组 NIHSS 低于机器人组、VR 组（P<0.05）。ADL 与 MMSE、FMA-UE 为正相 关关系，与 NIHSS 为负相关关系（P<0.05）。ADL 的变化受到 FMA-UE、NIHSS 和 MMSE 的影响。NIHSS、MMSE 在 FMA-UE 对 ADL 的影响关系中起到完全中介的作用。结论：上肢康复机器人联合 VR 互动干预对 sTBI 患者术后 康复具有积极意义，可以提高上肢运动功能，改善认知和神经功能，进而提高生活质量。

Objective: To investigate the improvement of activities of daily living (ADLs), cognitive function, and limb function in patients with severe traumatic brain injury (sTBI) who underwent upper limb rehabilitation robot training(ULRRT) combined with virtual reality (VR) interactive intervention after decompressive craniectomy (DC). Meanwhile, to explore the mediating effects of cognitive and neurological functions on the relationship between limb function and ADLs based on the Cognitive Behavioral Theory. Methods: Clinical data of 92 sTBI patients who were treated in the First Affiliated Hospital of Xi’an Jiaotong University from January 2019 to June 2023 was retrospectively analyzed. The patients were divided into the robot group (n=32), VR group (n=26) and joint group (n=34) according to different intervention ways. The robot group received conventional intervention + upper limb robot intervention, the VR group received conventional intervention + VR interactive intervention, while the joint group received upper limb robot training intervention + VR interactive intervention on the basis of conventional intervention. The national institutes of health stroke scale (NIHSS), mini-mental state examination (MMSE), FuglMeyer assessment of the upper extremity (FMA-UE) and ADL scale were used to evaluate and compare the degree of neurological deficits, cognitive function, upper limb function and ADLs of patients in the three groups. Results: After intervention, the MMSE, FMA-UE and ADL scores of the joint group were higher than those of the robot group and VR group (P<0.05), while the NIHSS of the joint group was lower than that of the robot group and VR group (P<0.05). The ADLs is positively correlated with MMSE and FMA-UE, and negatively correlated with NIHSS (P<0.05). The changes in ADL scale were influenced by FMAUE, NIHSS and MMSE. NIHSS and MMSE play a fully mediating role in the relationship between FMA-UE and ADL scale. Conclusion: The combination of upper limb rehabilitation robot combined with VR interactive intervention has a positive effect on the postoperative recovery of sTBI patients, which can improve patients’ upper limb motor function, cognitive function, and ultimately enhance their quality of life.

收稿日期：2024-01-11  录用日期：2024-05-19 

Received Date: 2024-01-11  Accepted Date: 2024-05-19 

基金项目：陕西省重点研发项目计划（2020JM-079） 

Foundation Item: Key R&D Project Plan of Shaanxi Province (2020JM-079) 

通讯作者：杨芳，Email：Yf15398067855@163.com 

Corresponding Author: YANG Fang, Email: Yf15398067855@163.com 

引用格式：王婷婷，蔺洁璐，李静，等 . 上肢康复机器人联合 VR 训练对重症颅脑损伤术后干预效果及对日常行为的中介效应研究 [J]. 机器人外科学杂志（中英文），2024，5（6）：1142-1148. 

Citation: WANG T T, LIN J L, LI J, et al. Study on the effect of upper limb rehabilitation robot combined with VR training on the postoperative recovery of severe traumatic brain injury patients and the mediating effect on daily behavior[J]. Chinese Journal of Robotic Surgery, 2024, 5(6): 1142-1148.

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