踝关节骨折康复机器人系统及其主被动康复控制方法

Ankle Fracture Rehabilitation Robot System and Active/Passive Rehabilitation Control Methods

摘要

踝关节骨折术后的康复训练对恢复患者踝关节的正常生理功能至关重要．然而，传统康复方法存在康复医师短缺、人力成本高及锻炼效果不佳等问题．随着现代医学与机器人学的交叉融合，康复机器人技术得到了广泛关注和应用．现有的踝关节康复机器人及其训练方法主要面向神经损伤康复，难以满足骨折康复的需求．为满足不同踝关节骨折患者在不同康复阶段的训练需求，本文开发了一种踝关节骨折康复机器人系统，并提出了被动和主动康复训练方法．首先，基于 R-3RRS-P 混联结构设计了踝关节骨折康复机器人，并开发了机器人控制系统来完成机器人运动调试、康复训练设置、实时信息显示以及安全配置等功能．基于机器人逆运动学，设计了位置控制器并提出了被动康复训练方法，能够根据患者的骨折情况设置个性化的训练范围．在主动康复方面，结合六维力传感器、位置控制器和导纳控制器，设计了自主活动训练和抗阻训练两种模式，能够根据患者的活动范围和力量参数，个性化设置导纳控制器参数．最后，选取健康受试者开展被动和主动康复训练试验．结果表明，机器人具有良好的跟踪性能，各康复训练模式均能达到设计效果，验证了踝关节骨折康复机器人系统及其康复训练方法的安全性和可行性．

Abstract

Rehabilitation training following ankle fractures is essential for restoring normal physiological function of the ankle joint. Traditional rehabilitation methods are limited，however，by a shortage of rehabilitation specialists，high labor expenses，and poor therapeutic outcomes. With the integration of modern medicine and robotics，rehabilitation robot technology has gained widespread attention and application. Current ankle rehabilitation robots and training methods are predominantly tailored for neurological injury rehabilitation，limiting their applicability to fracture rehabilitation. To meet the diverse training needs of ankle fracture patients across diverse rehabilitation stages，an ankle fracture rehabilitation robotic system had been developed，along with passive and active rehabilitation training methods. First，an ankle fracture rehabilitation robot based on the R-3RRS-P hybrid structure and a robotic control system were developed. The control system facilitated robot motion calibration，rehabilitation training configuration，real-time data display，and implementation of safety protocols. A position controller based on the robot’s inverse kinematics was implemented to support passive rehabilitation training，allowing individualized adjustment of the training range based on the patient’s fracture condition. For active rehabilitation，active range of motion training and resistance training modes were developed by integrating a six-dimensional force sensor with a position controller and an admittance controller. These modes enable individualized adjustment of the admittance controller parameters based on the patient’s range of motion and strength parameters. Finally，experiments using both passive and active rehabilitation training were conducted with healthy participants. The results indicate that the robot demonstrates excellent tracking performance，and all rehabilitation training modes successfully achieve the intended outcomes. These findings confirm the safety and feasibility of the ankle fracture rehabilitation robotic system and its associated training methods.

关键词

踝关节骨折康复机器人 / 并联机构 / 被动康复 / 主动康复

Key words

ankle fracture rehabilitation robot / parallel mechanism / passive rehabilitation / active rehabilitation

参考文献

[1] Juto H, Nilsson H, Morberg P. Epidemiology of adult ankle fractures：1756 cases identified in Norrbotten County during 2009—2013 and classified according to AO/OTA[J]. BMC Musculoskeletal Disorders, 2018, 19(1):441-449.

[2] Ovaska M. Complications in ankle fracture surgery[J]. Acta Orthopaedica, 2015, 86(Suppl 358):1-35.

[3] 张雨, 戴闽, 范红先, 等. 踝关节骨折术后踝关节功能的康复治疗[J]. 实用临床医学, 2012, 13(4):42-45.

[4] Zhang Yu, Dai Min, Fan Hongxian, et al. Rehabilitation treatment of ankle joint function after ankle fracture surgery[J]. Practical Clinical Medicine, 2012, 13(4):42-45(in Chinese).

[5] Siegler S, Chen J, Schneck C D. The three—dimensional kinematics and flexibility characteristics of the human ankle and subtalar joints—Part I：Kinematics[J]. Journal of Biomechanical Engineering, 1988, 110(4):364-373.

[6] van den Bogert A J, Smith G D, Nigg B M. In vivo determination of the anatomical axes of the ankle joint complex：An optimization approach[J]. Journal of Biomechanics, 1994, 27(12):1477-1488.

[7] Dul J, Johnson G E. A kinematic model of the human ankle[J]. Journal of Biomedical Engineering, 1985, 7(2):137-143.

[8] Girone M, Burdea G, Bouzit M, et al. A stewart platform—based system for ankle telerehabilitation[J]. Autonomous Robots, 2001, 10(2):203-212.

[9] Saglia J A, Tsagarakis N G, Dai J S, et al. A high—performance redundantly actuated parallel mechanism for ankle rehabilitation[J]. The International Journal of Robotics Research, 2009, 28(9):1216-1227.

[10] Dong M J, Zhou Y, Li J F, et al. State of the art in parallel ankle rehabilitation robot：A systematic review[J]. Journal of Neuro Engineering and Rehabilitation, 2021, 18(1):52.

[11] Jamwal P K, Xie S Q, Tsoi Y H, et al. Forward kinematics modelling of a parallel ankle rehabilitation robot using modified fuzzy inference[J]. Mechanism and Machine Theory, 2010, 45(11):1537-1554.

[12] Wang C, Fang Y, Guo S. Multi—objective optimization of a parallel ankle rehabilitation robot using modified differential evolution algorithm[J]. Chinese Journal of Mechanical Engineering, 2015, 28(4):702-715.

[13] Li J, Zuo S, Zhang L, et al. Mechanical design and performance analysis of a novel parallel robot for ankle rehabilitation[J]. Journal of Mechanisms and Robotics, 2020, 12(5):051007.

[14] Chen X C, Liu J X, Dong J A, et al. Analysis and optimization design of motion characteristics for a 3—PUU/R parallel ankle joint rehabilitation mechanism[J]. Robotica, 2024, 42(10):3450-3479.

[15] Zhang J J, Liu C L, Liu T, et al. Module combination based configuration synthesis and kinematic analysis of generalized spherical parallel mechanism for ankle rehabilitation[J]. Mechanism and Machine Theory, 2021, 166(12):104436.

[16] Zhang J J, Yang S, Liu C L, et al. Configuration and kinematics of a 3—DOF generalized spherical parallel mechanism for ankle rehabilitation[J]. Chinese Journal of Mechanical Engineering, 2024, 37(24):1-13.

[17] Adamson C, Cymet T. Ankle sprains：Evaluation，treatment，rehabilitation[J]. Maryland Medical Journal, 1997, 46(10):530-537.

[18] Bryan E. Phases of rehabilitation[J]. Foot and Ankle Clinics, 2013, 18(2):357-367.

[19] Yoon J, Ryu J, Lim K B. Reconfigurable ankle rehabilitation robot for various exercises[J]. Journal of Robotic Systems, 2006, 22(Suppl 1):S15-S33.

[20] Saglia J A, Tsagarakis N G, Dai J S, et al. Control strategies for patient—assisted training using the ankle rehabilitation robot(ARBOT)[J]. IEEE/ASME Transactions on Mechatronics, 2013, 18(6):1799-1808.

[21] Jamwal P K, Hussain S, Ghayesh M H, et al. Impedance control of an intrinsically compliant parallel ankle rehabilitation robot[J]. IEEE Transactions on Industrial Electronics, 2016, 63(6):3638-3647.

[22] Jamwal P K, Hussain S, Ghayesh M H, et al. Adaptive impedance control of parallel ankle rehabilitation robot[J]. Journal of Dynamic Systems，Measurement，and Control, 2017, 139(11):1-7.

[23] Dong M, Fan W, Li J, et al. A new ankle robotic system enabling whole—stage compliance rehabilitation training[J]. IEEE/ASME Transactions on Mechatronics, 2021, 26(3):1490-1500.

[24] Zhang M, Xie S Q, Li X, et al. Adaptive patient—cooperative control of a compliant ankle rehabilitation robot(CARR)with enhanced training safety[J]. IEEE Transactions on Industrial Electronics, 2018, 65(2):1398-1407.

[25] Li J F, Zhou Y, Dong M J, et al. Clinically oriented ankle rehabilitation robot with a novel mechanism[J]. Robotica, 2023, 41(1):277-291.

[26] Ni M N, Sun T, Zhang T, et al. Quantitative initial safety range of early passive rehabilitation after ankle fracture surgery[J]. Injury, 2022, 53(6):2281-2286.

[27] Sun Z D, Mu A L, Wang C B, et al. Research on an ankle rehabilitation robot for hemiplegic patients after stroke[J]. Proceedings of the Institution of Mechanical Engineers，Part H：Journal of Engineering in Medicine, 2023, 237(10):1177-1189.

[28] Ni M N, Liu J L, Sun Z, et al. Design and experiment of an ankle rehabilitation robot after fracture surgery[J]. Journal of Mechanisms and Robotics, 2024, 16(12):121014.

基金资助

中国博士后科学基金资助项目(2024M752356)

国家资助博士后研究人员计划资助项目(GZC20231911)

天津市应用基础研究重点资助项目(22JCZDJC00150，22JCYBJC01670)

绍兴市基础公益专项项目(2024A14003)

机构理论与装备设计教育部重点实验室(天津大学)开放基金