中国组织工程研究

中国组织工程研究 ›› 2026, Vol. 30 ›› Issue (17): 4457-4471.doi: 10.12307/2026.084

• 组织构建循证医学 evidence-based medicine in tissue construction • 上一篇    下一篇

中枢与外周康复技术影响脑卒中患者上肢功能和日常活动能力的网状Meta分析

陈金慧 1 ，于子夫 2 ，高世爱 1 ，曹新燕 1 ，冷晓轩 1 ，刘西花 3
  

  1. 1山东中医药大学康复医学院，山东省济南市   250355；2山东省疾病预防控制中心，山东省济南市   250014；3山东中医药大学附属医院康复科，山东省济南市   250014
  • 收稿日期:2025-02-26 接受日期:2025-05-19 出版日期:2026-06-18 发布日期:2025-12-03
  • 通讯作者: 刘西花，博士，主任医师，硕士生导师，山东中医药大学附属医院康复科，山东省济南市 250014
  • 作者简介:陈金慧，女，1999年生，贵州省毕节市人，汉族，山东中医药大学在读硕士，主要从事心肺和神经康复研究。
  • 基金资助:
    国家自然科学基金项目(81802239)，项目负责人：刘西花；山东省中医药科技项目(M-2023142)，项目负责人：刘西花；山东省医务职工科技创新计划项目(SDYWZGKCJH2022024)，项目负责人：刘西花

Effects of central and peripheral rehabilitation therapies on upper extremity function and activities of daily living in stroke patients: a network meta-analysis

Chen Jinhui1, Yu Zifu2, Gao Shiai1, Cao Xinyan1, Leng Xiaoxuan1, Liu Xihua3   

  1. 1School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China; 2Shandong Provincial Center for Disease Control and Prevention, Jinan 250014, Shandong Province, China; 3Department of Rehabilitation, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong Province, China
  • Received:2025-02-26 Accepted:2025-05-19 Online:2026-06-18 Published:2025-12-03
  • Contact: Liu Xihua, MD, Chief physician, Master’s supervisor, Department of Rehabilitation, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250014, Shandong Province, China
  • About author:Chen Jinhui, MS candidate, School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, Shandong Province, China
  • Supported by:
    National Natural Science Foundation of China, No. 81802239 (to LXH); Shandong Province Traditional Chinese Medicine Science and Technology Project, No. M-2023142 (to LXH); Shandong Province Medical Workers Science and Technology Innovation Program, No. SDYWZGKCJH2022024 (to LXH) 

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摘要：


文题释义：
脑卒中上肢运动功能障碍：为脑卒中后最常见的功能障碍，55%-75%的患者在脑卒中后6个月遗留上肢运动功能障碍，与患者日常生活活动能力呈正相关。
中枢或外周康复方法：通过作用于脑卒中患者大脑或肢体，增强神经可塑性与运动再学习能力，进而改善患者上肢运动功能与日常生活活动能力的康复方法。

目的：上肢运动障碍是脑卒中患者最常见的并发症，患者功能障碍表现在外周肢体，而病变位于中枢大脑，然而目前仍缺乏不同中枢与外周干预方法单独或联合应用对脑卒中患者上肢运动功能及日常生活活动能力影响的Meta分析，给临床选择最佳康复手段带来一定限制。采用网状Meta分析方法比较4种常用中枢康复方法(经颅磁刺激、经颅直流电刺激、镜像疗法与运动想象)与4种常用外周康复方法(康复机器人、肌电生物反馈、强制性运动疗法及功能性电刺激)单独或联合应用对脑卒中上肢运动功能及日常生活活动能力的影响，确定最佳康复方案。
方法：计算机检索PubMed、Web of Science、Embase、The Cochrane Library、中国知网、万方、维普、中国生物医学文献服务系统，时限为数据库建库至2024-10-15，收集不同中枢或外周康复方法单独或联合应用对脑卒中患者上肢功能及日常生活活动能力的随机对照试验。使用Cochrane手册和修订版Jadad量表评价纳入文献偏倚风险和方法学质量，采用RevMan 5.4与Stata 18对Fugl-Meyer评定量表上肢部分评分、Wolf运动功能测试与改良Barthel指数进行网状Meta分析，使用GRADE证据等级系统评估结局指标的证据等级推荐强度。
结果：①共纳入88篇研究，其中高质量82篇，低质量6篇，涉及5 561例脑卒中患者，共形成19种康复方案；②Fugl-Meyer评定量表上肢部分评分累积排序概率图下面积排序前8种康复方案：经颅直流电刺激+机器人(99.4%) >运动想象疗法+机器人(84.4%) >运动想象疗法+强制性运动疗法(82.8%) >镜像疗法+肌电生物反馈疗法(81.2%) >运动想象疗法+肌电生物反馈疗法(77.0%) >重复经颅磁刺激+强制性运动疗法(69.9%) >
经颅直流电刺激+肌电生物反馈疗法(67.1%) >重复经颅磁刺激+肌电生物反馈疗法(60.2%)；③Wolf运动功能测试累积排序概率图下面积排序前3种康复方案：强制性运动疗法+经颅直流电刺激(70.7%) >强制性运动疗法(65.3%) >经颅直流电刺激(63.4%)；④改良Barthel指数累积排序概率图下面积排序前8种康复方案：经颅直流电刺激+机器人(95.4%) >经颅直流电刺激+肌电生物反馈疗法(82.3%) >运动想象疗法+强制性运动疗法(79.7%) >重复经颅磁刺激+强制性运动疗法(79.5%) >功能性电刺激(74.2%) >运动想象疗法+肌电生物反馈疗法(68.6%) >镜像疗法+机器人(65.1%) >镜像疗法+肌电生物反馈疗法(51.0%)。
结论：中等证据强度推荐经颅直流电刺激+机器人为促进脑卒中患者上肢运动功能及日常生活活动能力的最佳康复方案，中枢联合外周的康复方法对提高脑卒中患者上肢运动功能及日常生活活动能力的疗效优于单一康复手段，未来应开展更高质量及多中心的临床试验以验证该结果。

https://orcid.org/0009-0009-6437-8102 (陈金慧) 


中国组织工程研究杂志出版内容重点：干细胞；骨髓干细胞；造血干细胞；脂肪干细胞；肿瘤干细胞；胚胎干细胞；脐带脐血干细胞；干细胞诱导；干细胞分化；组织工程

关键词: 脑卒中, 上肢, 运动功能, 日常生活活动能力, 经颅磁刺激, 经颅直流电刺激, 康复机器人, 镜像疗法

Abstract: OBJECTIVE: Upper extremity dyskinesia is the most common complication in stroke patients, mainly manifested in the peripheral limbs, while the lesions are located in the central brain. However, there is still a lack of meta-analysis of the effects of different central and peripheral interventions applied alone or in combination on the upper extremity motor function and activities of daily living in stroke patients, which imposes a certain limitation on the clinical selection of the best rehabilitation approach. Here, a network meta-analysis was conducted to assess the clinical efficacy of four commonly used central rehabilitation methods (transcranial magnetic stimulation, transcranial direct current stimulation, mirror therapy and motor imagery) and four commonly used peripheral rehabilitation methods (rehabilitation robotics, constraint-induced movement therapy, electromyography biofeedback, and functional electrical stimulation) applied alone or in combination on the motor function of the upper limbs and activities of daily living in stroke patients, thereby determining the optimal rehabilitation program. 
METHODS: A computer search of PubMed, Web of Science, Embase, The Cochrane Library, CNKI, WanFang, VIP, and the Chinese Biomedical Literature Database. The time period was from database inception to October 15, 2024. Randomized controlled trials of different central or peripheral rehabilitation methods alone or in combination on upper limb function and activities of daily living in stroke patients were collected. The risk of bias and methodological quality of the included literature were evaluated using the Cochrane Risk of Bias Assessment Tool and the revised Jadad scale. Network meta-analyses of Fugl-Meyer Assessment-Upper Extremity, Wolf motor function test and Modified Barthel index were performed using RevMan 5.4 and Stata 18. The strength of recommendation for the outcome metrics was assessed using the GRADE Level of Evidence system. 
RESULTS: (1) A total of 88 studies were included, including 82 high-quality and 6 low-quality studies, involving 5 561 stroke patients, resulting in a total of 19 rehabilitation programs. (2) The Fugl-Meyer scale results indicated that the top eight rehabilitation programs, ranked by the area under the cumulative ranking probability chart, were transcranial direct current stimulation+robot (99.4%) > motor imagery therapy+robot (84.4%) > motor imagery therapy+constraint-induced movement therapy (82.8%) > mirror therapy+electromyography biofeedback (81.2%) > motor imagery therapy+electromyography biofeedback (77.0%) > repetitive transcranial magnetic stimulation+constraint-induced movement therapy (69.9%) > transcranial direct current stimulation+electromyography biofeedback (67.1%) > repetitive transcranial magnetic stimulation+electromyography biofeedback (60.2%). (3) Wolf motor function test results indicated that the top three rehabilitation programs, ranked by the area under the cumulative ranking probability chart, were constraint-induced movement therapy+transcranial direct current stimulation (70.7%) > constraint-induced movement therapy (65.3%) > transcranial direct current stimulation (63.4%). (4) Modified Barthel index results indicated that the top eight rehabilitation programs, ranked by the area under the cumulative ranking probability chart, were transcranial direct current stimulation+robot (95.4%) > transcranial direct current stimulation+electromyography biofeedback (82.3%) > motor imagery therapy+constraint-induced movement therapy (79.7%) > repetitive transcranial magnetic stimulation+constraint-induced movement therapy (79.5%) > functional electrical stimulation (74.2%) > motor imagery therapy+electromyography biofeedback (68.6%) > mirror therapy+robot (65.1%) > mirror therapy+electromyography biofeedback (51.0%).
CONCLUSION: The moderate strength of evidence recommends transcranial direct current stimulation+robot as the optimal rehabilitation protocol to promote upper limb motor function and activities of daily living in stroke patients. The central combined with peripheral rehabilitation approach is superior to a single means of rehabilitation to improve upper limb motor function and activities of daily living in stroke patients. Higher-quality and multicentral clinical trials should be carried out in the future to validate the results of this study.


Key words: stroke, upper limb, motor function, activities of daily living, transcranial magnetic stimulation, transcranial direct current stimulation, rehabilitation robot, mirror therapy

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