下肢外骨骼相关辅具在行走障碍人群中的康复应用及发展

The Rehabilitation Application and Development of Lower Limb Exoskeleton-Related Assistive Devices among People with Walking Disabilities

摘要: 下肢外骨骼作为新型可穿戴康复辅具，近年来在神经损伤及老年性步态障碍患者康复中的应用价值日益凸显。其通过机械结构或动力系统辅助下肢动作，可改善步态功能、增强自主运动能力，并在一定程度上促进神经可塑性。本文基于外骨骼系统中被动免荷(无动力)与主动免荷(有动力)两大核心分类，系统梳理了其生物力学基础、结构特征及技术发展现状，比较了两类系统在适用人群与控制方式上的差异，并重点分析其在脑卒中、脊髓损伤及脑瘫等行走障碍人群中的康复应用。进一步探讨被动免荷外骨骼向智能化升级、主动免荷外骨骼向轻量化演进的双向发展趋势，并分析其在人工智能、脑机接口(BCI)、功能性电刺激(FES)等前沿技术融合背景下的创新潜力。最后，结合家庭及社区等多元化场景应用需求，提出外骨骼康复辅具未来在标准体系建设、适配性优化等方面的发展方向。旨在为下肢外骨骼的临床转化与多学科研究提供理论支持与实践参考。

Abstract: As a novel wearable rehabilitation device, the lower-limb exoskeleton has demonstrated increasing clinical value in recent years for the rehabilitation of patients with neurological injuries and age-related gait disorders. By providing mechanical support or powered assistance to lower-limb movements, it can improve gait performance, enhance voluntary motor function, and, to some extent, promote neuroplasticity. Based on the two core categories of exoskeleton systems—passive unloading (non-powered) and active unloading (powered)—this review systematically summarizes their biomechanical principles, structural features, and current technological developments. It further compares the two systems in terms of applicable patient populations and control strategies, with a focus on their rehabilitation applications in individuals with stroke, spinal cord injury, and cerebral palsy. The paper also explores the bidirectional evolution trend: passive lower-limb exoskeleton advancing toward intelligent upgrades, and active lower-limb exoskeleton progressing toward lightweight and energy-efficient designs. In addition, it discusses the innovative potential of these systems under the integration of cutting-edge technologies such as artificial intelligence (AI), brain–computer interfaces (BCI), and functional electrical stimulation (FES). Finally, considering the growing demand for rehabilitation in home and community settings, the paper proposes future directions for exoskeleton assistive devices in terms of standardization, adaptability, and clinical implementation. This review aims to provide theoretical insights and practical references for the clinical translation and interdisciplinary development of lower-limb exoskeletons.